First Name:	Last Name:
Street Address 1:	City:
State:	Zip Code:
Home Phone: ( ) -	Work Phone: ( ) -
Mobile Phone: ( ) -	Email Address (Primary)
Email Address (Secondary)
Gender (optional) Male Female	Have you seen any advertising for The Row at Ghent? (please indicate all that apply) Virginian Pilot Portfolio Weekly Realtor Magazine Hampton Roads Internet Other
Marital Status (optional) Single Married Committed relationship	Preferred number of bedrooms: One Two
Age of prospective buyer (optional): 25 or younger 26-30 31-35 36-45 46-55 56+	When are you interested in moving? 1-3 months 3-6 months 6-9 months 9-12 months 12+ months
I am interested in homes priced from: $100,000-$200,000 $200,000-$300,000 $300,000-$400,000	Where do you currently live? Apartment Condo Townhouse Single family home Temporary housing
Are you represented by a sales agent or realtor? Yes No	What is the primary reason for your purchase? First time homeowner Downsizing from a home I own Lifestyle change Relocating to Norfolk Desire to live in town Second home in addition to primary residence Investment purposes
Agent:	How did you first learn about The Row at Ghent? Read about The Row at Ghent in the news Saw the building or signage Saw an advertisement Agent referral Referral from a friend Internet Other
Agency: