Sam Hedrick - CharlestonHomesAndLand.com ~ (843) 884-7300

Please complete this form for information on the city of your choice. We will have one of our agents contact you.

I will be:	Buying Selling
My Name:
Number of children:
Ages of children:
Current Address:
City:
State:
Zip:
Destination City & State:
Preferred Area of the destination city:
The best time(s) to contact me:
Home Phone:
Work Phone:
Email Address:
My present home is:	Currently for Sale Listing Price: $ Sold Sale Price: $ I currently rent
Price range of new home:
I wish to rent short term, then buy:	Yes No
New property needs:
Style of Property:
Number of Bedrooms:
Number of Baths:
New or Resale:	New Resale
I would be interested in: (check all that apply)	Mortgage Information Homeowner's Insurance Information Moving Van Assistance
Expected date of first visit:
After arrival, I can be reached at:
Transfer / Move date:
Destination Employer's Name:
Address:
Phone:
Name of AgentOwned Sales Associate: (if known)
Any additional comments:

Sam Hedrick
AgentOwned Realty Company
824 Johnnie Dodds Blvd., Mt. Pleasant, SC 29464