Please fill-up this form and we will immediately get back to you to provide more information. All information you will provide will be treated with utmost confidentiality. Personal Information First Name * Last Name * Maiden Name Birthdate * January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Address Telephone No. * Mobile Phone No. Gender * Male Female Email * Civil Status * Single Married Separated Widowed About your Company Type of Employment -------------------------- Locally Employed Self-Employed OFW Occupation/Position Industry ------------------------------------------------- Accounting, Audit Advertising Agriculture Airlines Architecture Banking, Finance, Investment Chemicals Clubs, Associations Computer Consulate, Diplomat,Ambassador Cosmetics Education Engineering Entertainment Food and Beverage Garment, Textile, Fashion Government Information Technology Insurance Journalism Legal Firms Management Manufacturing Marketing Medical, Hospital Pharmaceuticals Print Media, Magazines, Newspaper Real Estates Telecommunications Television Tourism, Travel Trading, Import, Export Transporation, Shipping Company Name Company Address Company Telephone No. Remarks Other Information Do you plan to buy a residential property? Yes No If yes, what type of property? House and Lot Condominium Lot/s Only If yes, when do you plan to buy a house? Immediately Within a year Next year Within 3 years If yes, where is your preferred location? Makati/Fort Bonifacio Mandaluyong/San Juan Marikina/Quezon City Sucat/Alabang Paranaque/Las Pinas Pasay/Roxas Pasig/Marikina Taguig/Pateros Caloocan/Novaliches Cainta/Antipolo Laguna Cavite Bulacan Other How much is your budget? Less than P1 Million P 1.0 - 1.5 Million P 1.6 - 2.0 Million P 2.1 - 3.0 Million P 3.1 - 4.0 Million P 4.1 - 5.0 Million P 5.1 - 6.0 Million P 6.1 - 7.0 Million P 7.1 - 8.0 Million P 8.1 - 9.0 Million P 9.1 Million and above Do you know anyone who is willing to buy a house? Yes No If yes, what location? Referrals Name Contact No. 1. 2. 3. 4. 5.