Buyers Request Form



I'm pleased that you're interested in speaking with me.  In order for me to contact you,  please fill-out the following Buyers Request Form. Your response is appreciated and will greatly help in your upcoming move.

(Fields with an * are required)

I respect your privacy and will not release, sell or give your information to any other party or organization.


Input Your Information
Buyers Request Form
* Name
* Email
* Address
* City
* State
* Zip
* Approximate Date you Plan to Buy (mo/day/yr):
* Are you Renting?
* Must sell home to buy?
* Looking to purchase a Residential Property?
* Looking for an Investment Property?
* Community, City or Area Desired
* Minimum Number of Bedrooms
* Minimum Number of Baths
* Minimum SQFT
* Size of Car Garage
* Price Range Desired
Type of Living, Family, Adult, Golf etc
* Do You Have Financing in Place?
* Are You Currently Working With Another Realtor?
Any Special Requests, Questions or Concerns?
* How Did You Hear About My Website? Internet, Newspaper, Direct Mail, Yard Signs, Radio, TV, Referral, Other


West USA Realty
15128 W Bell RD #10 • Surprise, AZ 85374
BETTY HARMON * DIRECT: (602) 574-3783 • *Each office is independently owned and operated*
EMAIL: * FAX: (888) 882-7715
Direct: (602) 574-3783 * Office: (602) 942-4200
Betty Harmon, REALTORĀ®, GRI