Name: (Required)

Email: (Required)

Street Address:

City:

State:

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Zip:

Home Phone:

- -

Work Phone:

- -

Cell Phone:

- -

Fax:

- -

Best time to reach me by phone:

Morning Noon Afternoon Evening

I prefer to be contacted by:

Phone E-mail Either, thanks

Are you currently working with a Sales Person?

Choose One No Yes Yes, I am working with a Realtor

Have you been pre-approved for a mortgage?

Yes No No, but I have been pre-qualified I am not certain

Will you be selling a home?

Yes Yes, and I need to sell before I buy No

How did you hear about us?

Choose One A Groza Builders Team Member Newspaper Advertisement Online Advertisement Home Magazine Advertisement Referred Friend Web Search Other

Do you own a lot?

Yes No No, but I am working with a realtor

How long before you expect to buy?

Choose One Immediately Within 3 months 3-6 months 6-12 months 1 Year or More

Preferred Location:

None Port St. Lucie St. Lucie County Indian River County Martin County Palm Bay Fort Pierce Stuart

What is your Price Range?

K  to K

Do you need or want location information?

Yes No

Number of bedrooms:

No minimum 1 2 3 4 5

Number of baths:

No minimum 1 2 3 4

Garage:

No minimum 2 3 4

Minimum Square Feet?

Please Mark Desired Features:

Living Room  

Formal Dining Room

Family Room

Eat-in Kitchen

Great Room

Guest Suite

Describe Your Perfect Home For Us: