| I am inquiring: | for myself/spouse for my parents for a friend for a relative |
| Name: | |
| Email: | |
| Phone: | |
| Mailing Address: | |
| City, State & Zip Code: | |
| Comments/Questions: | |
| When Do You Plan to Retire? | Less than 6 months 6 months to 1 year 1 - 2 years Not sure |
| Type of Home/Community You Are Interested In: | Ownership Rental Buy-in Not sure |
| Do you Own or Rent your Primary Residence? | Own Rent |
| Additional Information (Optional): The information you submit below is entered into a general consumer profile - your input is appreciated. If you do not wish to answer these questions, scroll down to the bottom of this page and click "SUBMIT FORM" to receive your free information. |
Which of the following reasons might motivate you to move from your present home in the future?
(Check All That Apply) | To be closer to family members To have less home and lawn maintenance To have more opportunities to be with friends To have more opportunities to participate in recreational activities To have more opportunities for cultural & educational activities To have more opportunities for social events To have more security To reduce the cost of household expense To obtain a smaller home (downsize) To be in a more convenient location To have more transportation options To obtain assistance for health problems Other |
| If you were to move to a Retirement Community Setting, which Type of Community do you Prefer? | A community for adults (55 years and up) A community for people of all ages No preference |
| If you were to move to the Community you chose above which would you prefer? | Own Rent No preference |
| If you were to move to this Community, when might that be? | Within 1 year Within 2 years Within 3 years Don't know |
| About what Price Range would you consider for a home in this Community? | $100,000 to $124,999 $125,000 to $149,999 $150,000 to $174,999 $175,000 to $199,999 $200,000 to $249,999 $250,000 to $299,999 $300,000 and up |
| What Size Residence would you Prefer? | Less than 1,000 square feet 1,000 to 1,500 square feet 1,501 to 2,000 square feet 2,001 to 2,200 square feet More than 2,200 square feet Other |
| How many Bedrooms would you prefer in your home? | One Two Three Four |
| How many full Bathrooms would you prefer? | One Two Three Four |
| What is your opinion of a Community designed for those who are 55 years of age and up? Would you say age-qualified housing is... | Very Appealing Appealing Neither Appealing or Unappealing Unappealing Very Unappealing |
| What is your Age? | |
| What is your Gender? | Male Female |
| What is your Marital Status? | Married Divorced or separated Widowed Single, never married |
| What is your Current Employment Status? | Employed Full time Employed Part time Retired Unemployed (seeking employment) Homemaker |
| What is the Highest Level of Education you have Completed? | Grade School or less Some High School High School Graduate Some College College Graduate Graduate Degree |
| If you were to purchase or rent a new home for retirement, would it be dependent upon the sale of your Current home? | Yes No |
| What is your best estimate of the Current Market Value of your home? That is, if you were to sell your home today, for how much do you think it would sell? | Less than $75,000 $75,000 to $99,999 $100,000 to $124,999 $125,000 to $149,999 $150,000 to $174,999 $175,000 to $199,999 $200,000 to $249,999 $250,000 to $299,999 $300,000+ |
| How Did You Find Our Web Site? | Publication (Please Specify): Friend or Relative Website Link (Please Specify): Search Engine (Please Specify): |
