Name:


Street Address:


City

State

Zip Code

Home Phone:


Work Phone:


Fax:


E-mail:

To help us better serve you, please answer the following:

What is the best method and time of day to contact you?

What style(s) of home are you most interested?

Single-Level ?
First-floor Master Suite?
Two Story?

In what size of home are you most interested? (Check all that apply.)

Under 1,600 Square Feet?
1,600 to 2,000 Square Feet?
2,000 to 2,400 Square Feet?
2,400 to 2,800 Square Feet?
2,800 to 3,200 Square Feet?
3,200 to 3,600 Square Feet?
Over 3,600 Square Feet?

In what price of home are you most interested?
(Total price excluding home site. Check all that apply.)

Under$150,000?
$150,000 to $200,000?
$200,000 to $250,000?
$250,000 to $300,000?
$300,000 to $350,000?
$350,000 to $400,000?
$400,000 to $450,000?
$450,000 to $500,000?
Over $500,000

Do you already own a home site suitable for the construction of your new home or have one under contract?

Yes
No

In what area is your home site located?

County?


City?

If you do not already own a home site, in what area(s) are you most interested?

When would you like to start working toward your new home purchase?

Now - Almost immediately?
Within 30 days?
30 days to 3 months from now?
3 to 6 months from now?
6 to 9 months from now?
9 to 12 months from now?
Over a year from now?

How did you first hear about Piedmont Personal Builders?

Searching the internet
Saw a Piedmont Personal Builders lot sign
Saw a Piedmont Personal Builders home under construction
Saw an ad in a newspaper
Saw an ad in New Homes Guide
Saw an ad in a homes magazine
Saw an ad on television
Received direct mail information
A friend told me about Piedmont Personal Builders. (Please tell us their name so we can thank them: Name Address Tel .)
At a Home Show
At a Parade Of Homes

Name:


Address:


Telephone:

Please describe what information you need or how we can best assist you in your housing search.





Revised 08-15-06