PRINCIPAL BROKER:
Herb Goddard
P.O. BOX 760
RHINEBECK,
NEW YORK
12572
Cell Phone
845.750.9898
Office Phone
845.871.1760
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Last Name
First Name
*Full Name
Business Phone
Cell Phone
Home Phone
*e-mail
Address
City /State / Zip
How did you
find out about us?
In what area are you hoping to purchase?
Please choose area
Rhinebeck Village
Rhinebeck Town
Rhinecliff
Red Hook
Milan
Clinton
Tivoli
Staatsburg
Hyde Park
Millbrook
Pine Plains
What type of home
were you hoping
to purchase?
Please choose type
Colonial - Early
Colonial - New
Federal
Salt Box
Greek Revival
Contemporary
Ranch
Cottage
Farm
Estate
Other
Please list
important features
you wish to have
in your new property
Financial Information
Desired price range
Have you explored your mortgage options?
?
Yes
No
Cash purchase mortgage not exceeded
Do you have
a mortgage
commitment letter?
?
Yes
No
Mortgage company name
Contact name
Contact phone number