NEW SELLER CLIENT FORM This form serves as your request to have an agent from your current locale to contact you regarding listing your property for sale. This agent should contact you within five to seven working days of your submitting this request. If you wish to speak to a relocation specialist directly, call 1-800-429-4663, leave a message and your call will be returned. Thank you for using our services. INSTRUCTIONS: - Fill in the blanks (move your cursor over the blanks and click). - When finished, click on the "SUBMIT" button. The first 6 fields are required fields. The information you submit is confidential and will not be sold to marketers. NAME: STREET: CITY: STATE ZIP CODE HOME PHONE: WORK PHONE: E-MAIL: TYPE PROPERTY TO SELL (HOME, COMMERCIAL, ETC.): IS THE PROPERTY CURRENTLY LISTED?: IF SO, WITH WHAT COMPANY?: ESTIMATED LIST PRICE, IF KNOWN: AGE OF PROPERTY: #BEDROOMS: #BATHS: GARAGE: FIREPLACE: HEATED SQUARE FOOTAGE, IF KNOWN: ADDITIONAL INFORMATION: How did you locate www.gay-homes.com? For instance, website (if so, please name the website), flyer, friend, advertisement, direct mail, etc.

Across America Real Estate Network J. Mark Kasper, Owner, Licensed Real Estate Broker & Broker-in Charge P.O. Box 23696, Oakland Park, FL 33307 Toll-Free 800-GAY-HOMES (800-429-4663) Fax: 815-361-7408

Nation-wide relocation referral source for the homosexual population on the move. We match
home buyers and sellers with gay/lesbian or supportive real estate agents throughout the United States.
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Nation-wide relocation referral source for the homosexual population on the move. We match home
buyers and sellers with gay/lesbian or supportive real estate agents throughout the United States.
Gay, Real Estate, Relocation, Lesbian, Realtor, Nationwide, Referral, Realty, Gay Realtors, Gay Real Estate Agents,
Residential, Agent, Homosexual, Gay property, commercial, home, seller, buyer, broker, Gay Real Estate, Gay Real Estate Agents
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