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| * First Name |
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| * Last Name |
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* E-mail Address
(ex: bobsmith@aol.com) |
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| Street Address 1 |
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| Street Address 2 |
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| City |
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| State |
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| Zip Code |
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| Daytime Telephone |
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| Evening Telephone |
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| What is your age? |
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| What is your combined
household income? |
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| Do you currently own your
own home? |
Yes
No |
| Is your home currently:? |
Sold
On the market
Not listed |
| How long have you been
looking for a new home? |
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| How many people will be
living in your new home? |
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| What type of new home
are you looking for? |
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| Desired number of bedrooms? |
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| What are the most important
features you are looking for in a new home? |
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| What is the price range
of your ideal new home? |
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| What city do you work
in ? |
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| Are you working with a
realtor? |
Yes
No |
| Choose one or more communities
that you are interested in |
Cavanagh Courts/Kenosha
Oakcrest Estates/Huntley
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| How did you hear about
us? |
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| How would you like to
be contacted? |
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| Have you visited a Robinson
Homes community before? |
Yes, which one(s)
No |
| Do you currently live
in a Robinson Homes community? |
Yes
No |
| What do you think are the strengths of Robinson Homes? |
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| Do you have any additional
comments or a specific question? |
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