*First Name:

*Last Name:

*Property Address:

*Property City:

*Property Zip code:

*Is your address different from the property address?
Yes No
If yes, please list your primary address

*Email Address:

*Contact Phone Number:

Is there a specific time of the day when you prefer that we call you?
Morning Afternoon Evening Weekends Only Weekdays Only

*Which of our locations is most convenient to you?
Naugatuck Waterbury Torrington

*Type of Property:
Single Family Home Multi-family home Townhouse Condominium Undeveloped residential property/lot

Approximate year built:

Approximate square footage:

Approximate lot size:

Home style (examples: colonial, cape cod, ranch, split level):

*Bedrooms:

*Full baths:

Half baths:

Formal living room:
Yes No

Family room:
Yes No

Formal dining room:
Yes No

Eat in kitchen:
Yes No

Breakfast nook:
Yes No

Basement:
Yes No

Finished basement:
Yes No

Fireplace:
Yes No

Parking for single family homes

Attached garage:
Yes No
If yes, parking spaces:

Unattached garage:
Yes No
If yes, parking spaces:

Carport:
Yes No
If yes, parking spaces:

Off-street parking:
Yes No
If yes, parking spaces:

Parking for multi-family homes, townhouses and condominiums

Covered parking/parking garage:
Yes No
If yes, parking spaces:

Off-street parking:
Yes No
If yes, parking spaces:

Utilities

Heat type:

Air conditioning type:

Additional features
Pool
Jacuzzi/hot tub
Other: please describe:

Are there any other free standing structures on your property (e.g. shed, barn, boat dock, etc.)
Yes No
If yes, please describe:

*Please rate the overall condition of your home and property. [1-10 10=Excellent 1=Very Poor]
1 2 3 4 5 6 7 8 9 10

Additional comments

Please describe any features or recent upgrades that you believe add value to your property (e.g. new stainless steel kitchen appliances, new carpeting, remodeled bathroom, etc.)

*Are you currently working with a Real Estate agent?
Yes No

If you like to request a specific Coldwell Banker Realty 2000 agent, please list the agents name.
Last Name:

First Name: