Please complete the form below to let us know what type of home you would prefer to own.  The fields with  a + must be completed.  We look forward to working with you.

+First Name +Last Name

+Street Address



+Zip Code


Cell Phone

+E-Mail Address

Number of Bedrooms
Number of Baths
3 4 5 6 2 3 4

Price Range
Square Footage

Preferred Location

When would you need to move into the home?

Any additional features/amenities that you are interested in?



Sheila Marchman, Realtor�, CDPE
Allegiance Real Estate Services, Inc.
128 John King Rd.; Suite 6  Crestview, FL 32539
Office: (850)423-7991   Fax: (850)423-7993

               Copyright � 2006 Sheila Marchman, Realtor�.  All Rights Reserved  |  Site by VTD, Inc.