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First Name:
Last Name:
Address:
City:
State:
Zipcode:
Telephone
Telephone2
Email Address:
How did you hear about us?
Select
Newspaper
Billboards
Seminar Shows
Motor Coach Rally
AARP Bulletin
Modern Maturity Magazine
Motorcoach Magazine
Where to Retire Magazine
Mature Living Magazine
FMAC Magazine
Internet/Web Search
Friends/Family
Realtor
Direct Mail
Other
How would you like to receive information?
Telephone
Email
Postal Mail
Best time to contact you?
Morning
Evening
Afternoon
Tell us a little bit about yourself:
When do you plan to purchase?
1 to 3 months
4 to 6 months
7 to 12 months
1 to 2 years
2 to 3 years
Over 3 years
What type of purchase?
Villas
Single Family Home
Square footage required?
1000-1499
1500-1999
2000-2499
2500-3000
Are you relocating?
Yes
No
Are you Retiring?
Yes
No
Your present residence:
Own
Rent
Features most important to you?
Gated Community
Waterfront
Nature Areas
Clubhouse
Amenities most important to you?
Swimming
Movie Theatre
Tennis
Shuffleboard
Library
Exercise Facilities
Will this be your primary residence?
Yes
No
Questions or Comments:
Would you like to recieve E-mail updates?
Yes
No
Vienna Square
1387 Vienna Square Drive
Winter Haven, FL 33884
(877) 791-9907 • (863) 326-9219 Fax
© 2008 Vienna Square, One of CRF Communities
Florida Retirement Communities
-
Florida's best places to retire!