General Request Form


Please fill out the following general real estate request form. Tell me a little bit about how I can help you. Thanks again and all inquiries will be responded to in a timely fashion.

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

Input Your Information
General Request Form
* Name
* Email
Would you like to be contacted by phone?
* Are You Currently Working With another Realtor?
Please enter any special requests and/or questions and tell me a little about how I can assist you.
* How Did You Hear About My Website? Internet, Newspaper, Direct Mail, Yard Signs, Radio, TV, Referral, Other
Thank You for Visiting My Website, I will contact you promptly.


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