COASTAL HOME SOLUTIONS, INC. - (831) 663-1114

Please fill out this quick questionnaire so that we may better assist you.

We are looking forward to assisting you in finding your dream home. Please fill out the following form so we can better assist you, and we will get back to you as soon as possible.

 

First Name:

Last Name:

Street Address:

City:

County:

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Zip Code:

Home Phone:

Business Phone:

Fax Number:

Email Address:

Do you own land? yes no

If yes, where?

Do you currently own your home? yes no

If yes, do you own a... Manufactured Home Site Built Home

How soon are you planning to purchase a new home? Less than 3 months 3 to 6 Months 6 to 9 Months

Would you like someone to contact you by telephone? yes no

Would you like us to send you a free information package? yes no

How did you learn about us?      Sign TV Newspaper Radio Family/Friend Internet Other Refferal

Where do you want to keep your payments?

Between $

and $

Comments or Questions:

Coastal Home Solutions Inc. 7850 Messick Rd. Prunedale, CA 93907 Phone (831) 663-1114 Fax (831) 663-1118 Office Hours: 9-5, 7 Days a week E-Mail Us

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