First Name/s    

  Last Name/s    

  Address          

  City, State, Zip  

  Are you building in:        IN     MI

  Do you currently have a lot?      Yes  No

  Would you like to be located within a subdivision?       Yes  No

  What is the approximate range for square footage on your home?       900-1100 1200-1400 1500-1700 1800-2000 2000 +

  When would you like construction to begin? 

  Who will handle your construction loan?       Gerard Homes  I will

  What kind of a floor plan are you looking for?        Ranch 2-Story 1 1/2 Story Other

   How many Bedrooms would you like?       Two Three Four Other

   How many bathrooms would you like?       One 1 1/2 Two 2 1/2 Three

   What price range are you trying to meet? 

   Do you need help finding good financing?     Yes   No

   Would you like to schedule a meeting with us?  Yes  No 

   Where did you here about Gerard Homes?       Referral Television Print Ad

    May we contact you?  Yes  No          

  Phone:         E-Mail Address      

Additional Information