Pat Stacey's Buyer Request Form

Best time of the day to reach
you at the above phone number:
Day
Evening
Any time

Alternate Phone Number
(Please include area code):


Best time of the day to reach
you at the alternate phone number:
Day
Evening
Any time

If yes, list the name of your REALTOR:

Have you ever purchased a home before?
Select Yes No

In what time frame do you wish to purchase a home?
Select Immediately Within 1 month in 1-3 months in 3-6 months in more than 6 months

The home I plan to purchase will be used as:
Select My principal residence Pied-a-terre (2nd home) An investment property Other

What price range will you be looking in?
From: Select $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $525,000 $550,000 $575,000 $600,000 $625,000 $650,000 $675,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,600,000 $1,700,000 $1,800,000 $1,900,000 $2,000,000 $2,250,000 $2,500,000 $2,750,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000 $9,000,000 $10,000,000 $10,000,000 Plus To: Select $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $525,000 $550,000 $575,000 $600,000 $625,000 $650,000 $675,000 $700,000 $750,000 $800,000 $850,000 $900,000 $950,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,600,000 $1,700,000 $1,800,000 $1,900,000 $2,000,000 $2,250,000 $2,500,000 $2,750,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000 $9,000,000 $10,000,000 $11,000,000 $12,000,000 $13,000,000 $14,000,000 $15,000,000 The Sky is the Limit

What location will you be looking in? (Select one or more)

McKenzie Valley
Pleasant Hill/Oakridge
South Lane Properties
Veneta/Elmira
Junction City
Florence Area
Thurston
Coburg I-5
North Gilham
Ferry Street Bridge
East Eugene
Southwest Eugene
West Eugene
Danebo
River Road
Santa Clara
Springfield
Mohawk Valley
Hayden Bridge

Don't fit into a checkbox?
List your preferred location here:

Additional information, comments, or questions.

All email addresses & names are kept confidential