Nebraska Referral & Relocation Form

Which Nebraska city do you intend to move to?   

Do you have a specific area in mind in that city?  no preference Downtown East Side West Side North Side South Side Outskirts Suburbs Beach area Beach front

Desired price range?   select one $1 - $50,000 $50,000 - $100,000 $100,000 - $150,000 $150,000 - $250,000 $250,000 - $500,000 over $500,000

Desired property? (select) select one House Condominium Townhouse Mobile Home Vacant Land Commercial Property Investment/Income Property

Desired # of bedrooms? (check one)   1   2   3   4   more

Desired # of bathrooms?(check one)    1   2   3   4   more

Desired garage? (check one)   none   1-car   2-car   more than 2-car

Do you request any special features?  

Tell us about your school requirements?  

Do you currently own or rent?    Own Rent

If you own your current house, did you already list it For Sale?   Yes No

Must you sell your current home before buying in your new location?   Yes  No

How can you be contacted?  (required)

Your first name   Last name

Address:  

City   State   ZIP

Area code   Phone number

E-mail address