Geertsma Homes Ltd.

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Realtor Name:		Realtor Email:
Realtor Phone Number:		Company:
Client Name:		Client Address:
Client Phone Number:		Client Email:

How did client hear about us?
Client owns existing home and plans to sell Yes No
Client approximate budget has been determined
Client has an idea of product desired (i.e. bungalow, 2 storey, floor area)
Client has an idea of desired location (i.e. rural/city)
Client wishes to build on own lot Yes No
Client wishes to have Geertsma Homes build on a lot available for sale Yes No
Client wishes to have Geertsma Homes contact regarding new projects or updates or would like an appointment Yes No (Geertsma Homes will not contact client unless asked to do so.)

	Notes: