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	First Name:  * Last Name:  * Address:  City:  Province:  ----------Select Province----------- N/A Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Other Prince Edward Island Quebec Saskatchewan Yukon Territory Postal Code:  Home Phone:  * Work Phone:  Cell:  E-mail:  * Please contact me...  By E-Mail By Phone By Cell *

	I/we have not signed a Buyer Agency Agreement or are otherwise committed to purchase a home through another Realtor®       * Please Put a Checkmark By which date do you wish to move?   Please identify the areas or neighbourhoods you would like to receive information on, you can use community names or street boundaries as your description. *  *  Condominium:  -----Select Type----- Apartments Townhouses Lofts  Freehold:  -----Select Type----- 2-Storey 3-Storey Bungalow Split-Level  Maximum   Price Range:  $100,000 - 125,000 $125,000 - 150,000 $150,000 - 175,000 $175,000 - 200,000 $200,000 - 250,000 $250,000 - 300,000 $300,000 - 350,000 $350,000 - 400,000 $400,000 - 500,000 $500,000 - 600,000 $700,000 - 800,000 $800,000 - 900,000 $900,000 - 1,000,000 $1,000,000 + Rental Property   Approximate  Sq. Footage:  less than 700 700-1100 1100-1500 1500-2000 2000-2500 2500-3000 3000-3500 3500-5000 5000 plus  Minimum. # Bedrooms:  1 2 3 4 5 6   Minimum # Bath(s):  1 2 3 4 5   Kitchens:  1 2 3  Parking Spaces Required:  1 2 3  Parking Type:  -----Select Type----- Street Driveway Off-Lane Garage   Required Features of House or Property:       Questions / Comments:

Royal LePage Signature Realty

49 The Donway West, Toronto, Ontario M3C 3M9

Phone (416) 443-0300

Fax (416) 443-8619