Your Name:
 Spouses Name:
Your E-mail:
 Spouses E-Mail:
Your Phone #'s:
 Spouses Phone#'s:
Your Fax #
 Spouses Fax#:
U.S. Mailing
Address:
 Text
Mail:
How do you
want us to
communicate
to you?:
Email:
Physical
Address:
Fax:
Phone:
Why are you planning to move?
When do you plan to move?
Are there any special features about your home?
Bedrooms:


Bathrooms:
Are you working with a Realtor?  Yes
No
Property Type?
 What city?
Residential
 Liberal
Multi-Family
Out of Town
Commercial
 Oklahoma
Acreage (if rural):
Land
 Other
In order to help us serve you and your friends better,
please let us know where you heard about Cory Barnett?
Friend
Radio
Yard Sign
Newspaper
Internet
Other
How do you
prefer written
communication
from us by:
Would you like
for Cory to keep
you updated on
new listings
through the
e-mail?
How would you
like us to contact
you:
US Mail:
E-mail:
 Fax:
Or Phone:
 Or E-mail:
Job Titles:
 How Long?
 Hours?
Spouses
Birth- date:
Wedding
Anniversary:
Your Birth-date:
Children's Names:                            Birth-Dates:                   Hobbies:  
Pet's Names:
Favorite
Restaurant:
What is your #1 Goal
this year?
Suggestions,
Comments,

Or If You Would Like
Your Friends To
Have the Same Level
Of Service Please
Write Us:
All information will remain
confidential.
Your Friends in
Real estate saving
you TIME and
MONEY.
Cory Barnett    
Broker

Liberal, KS
620.624.4201 Office
1.800.624.8082 Fax

Our Family is ready to serve your Family!