Interest List and Information Request Form
To better help us understand your needs and provide you with a better place to live,
please fill out the following questionnaire. Fields marked * are required

First name:

 *

Last name

 *

Address

 *

City, State,Zip:

 *

 * 

* 

Home phone:

 *

Format

(123) 456-7890

Work phone:

 *

Format

(123) 456-7890

E-mail

 *

Occupation:

Please Select Architecture Banking/Finance Biotechnology Construction Consulting Education Engineering Entertainment Executive/Management Full-Time Student Government/Public Service Medicine/Healthcare Information Technology/Computers Legal Non-Profit Real Estate Small Business Owner Transportation Other  

If the right home were available, I would want to move in:

Please Select 6 months to 1 year 1 or 2 years More than 2 years *

How did you hear about
Centre Street Lofts?:

Please Select Newspaper Magazine Website Radio Friend/Referral Other *

What price range are you
interested in?:

Please Select $350,000 to $500,000 $500,000 to $650,000 $650,000 to $850,000 $850,000 to $1,000,000 Over $1,0000,000 *

Desired Number of Bedrooms:

Please Select 1 2 3 4 More than 4 *

Desired Number of Bathrooms:

Please Select 1 2 3 4 More than 4 *

How Many Occupants
Will Live in Home:

Please Select 1 2 3 4 5 More than 5 *

Do you own or rent?:

Please Select Rent Own *

If I purchased a new home, I would:

Please Select Sell my current home Keep my current home *

Comments:

Thank you for participating.

For More Information Call:
(310) 241-1011