Request For Information

We're pleased that you're interested in speaking with us. In order for us to contact you, please fill out the information below. We respect your privacy and will not release your information to anyone outside of the Alpha Omega family.

	required fields are designated with an * Dr. Ms. Mrs. Mr.
First Name*:
Last Name*:
Street Address*:
City*:
State/Province*:	(Please select your State) Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon AE AP AA District of Columbia
Zip or Postal Code*:
E-mail Address*:
Phone Number:	- -
FAX:	- -

Please send information via: (Select One) Postal Service Fax

To where are you interested in buying?
City: State:

Date you plan to buy (mo/day/yr): / /

Property Type:	Select property type... single family home land town home condo
Price Range:	to
Number of Bedrooms:	Select number of bedrooms... one two three four or more
Number of Baths:	Select number of baths... one two three four or more
Are you presently renting?	Yes No
Must sell home to buy?	Yes No

Other special requirements:



Are you interested in school information? Yes No

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Optional Questionnaire We want to make this site a valuable resource to you, so it will be helpful to us to know more about you. This section is completely optional and under no circumstances will we release your responses to anyone. Thanks for your help. 1. How would you rate the overall site? Excellent Good Average Fair Poor 2. How did you learn about our web site? Search Directory (i.e.Yahoo!/Lycos/Alta Vista /etc.) On-line Advertisement Link from Another Home Page Newspaper/Magazine/TV Ad News Story Friend or Peer Surfing Other 3. What service did you use to access our site? America Online Prodigy Compuserve Microsoft Network AT&T WorldNet Netcom Other 4. At what speed do you access the web? 9600 bps 14400 bps 28800 bps 56k bps Cable modem ISDN T-1 or higher 5. From where do you connect? School Home Office

Please tell us about yourself! Your age: Marital status: Select marital status... Married Single Divorced Widowed Highest level of education attained: Select level of education... High School Some College Bachelors Masters Doctorate Annual household income: Select income level... $25000 to $34999 $35000 to $49999 $50000 to $59999 $60000 to $74999 $75000 to $99999 $100000 to $149999 $150000 to $199999 $200000 to $299999 $300000 or more

Thanks for taking the time to help us!

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