Please provide the following contact information:

First Name
Last Name
Work Phone including Area Code
Home Phone including Area Code
FAX including Area Code
E-mail
Property Street Address
Property City, State, Zip
Number of Bedrooms
Number of Bathrooms
Square Foot Heated
Construction Type	Block Brick Stone Stucco Frame Siding Asbestos Piling Other Mobile - Single Wide in Park Mobile - Single Wide outside/Park Mobile Double-wide in Park Mobile Double-wide outside/Park
Acreage Information	Up to 1/4 Acre 1/4 to 1/2 Acre 1/2 to 1 Acre 1 - 2 Acres 2 - 5 Acres 5 - 10 Acres 10+ Acres
Year Built
Garage	1-Car Carport 2-Car Carport 1-Car Garage 2-Car Garage 3+ Car Garage Oversized Garage Detached Attached Parking Pad RV/Boat Parking N/A
Pool	In-ground In-ground heated Above ground Vinyl Screen-Enclosure Hot Tub/Spa No Pool
Waterfront	Yes       No
Miscellaneous Requests

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I will contact you within 48 hours by phone or E-Mail.

Or, e-mail me your information to Info@MikePrillimanRealty.com

Thank you for selecting Mike Prilliman Realty, Inc.!  I look forward to working with you.