Tell Us About Your Project Realtor Intake Form NameThis field is for validation purposes and should be left unchanged.Contact Information If you already have an account with us, you can log on here.Name(Required) First Last Brokerage(Required)Email(Required) Phone(Required)Preferred Contact Method(Required)CallTextEmailBest Time to Reach You(Required)MorningMiddayAfternoonEvening Property InformationProperty Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Property Type(Required)Single FamilyCondoMultifamilyTownhouseIs this property:(Required)VacantOwner-occupiedTenant-occupiedParking / Access NotesPets? Yes No Pets present Project TypeProject Goal Pre-listing repairs & upgrades Post-inspection repairs Emergency repair Punch list / Handyman day Other Describe(Required)How urgent is this?(Required) Need contact within 24 hours This week 2-4 weeks Describe the work needed(Required)Upload photos/video of the area Drop files here or Select files Max. file size: 100 MB, Max. files: 10. Upload Inspection Report / Punch ListAccepted file types: pdf, jpg, jpeg, png, Max. file size: 100 MB. Listing Link (if live) Billing and ApprovalWho is Paying?SellerBuyerAgentOtherInvoice Email (if different) Agreement to Payment Terms I agree to Samar Real Estate Solutions payment schedule (30/30/30/10) and understand work begins after written approval. How You Heard About UsReferral source(Required) Other Real Estate Professional Friend / Family I'm a Previous Customer Google Search Facebook / Instagram Other Who can we thank? Next StepsHow do you prefer to proceed?(Required) Quick Phone Call (10-15 min) On-site visit / Estimate Video Walkthrough This field is hidden when viewing the formPhone Call BookingPhone Call BookingThis field is hidden when viewing the formPhone Call Resource Samar This field is hidden when viewing the formPhone Call Service This field is hidden when viewing the formOn-Site Estimate BookingThis field is hidden when viewing the formOnsite Visitation - Resource Samar On-site Estimate Booking CalendarThis field is hidden when viewing the formOnsite Visit - Service Selection This field is hidden when viewing the formVideo Walkthrough BookingVideo booking blockThis field is hidden when viewing the formVideo Book Resource Samar This field is hidden when viewing the formvideo Service Communications Consent I consent to be contacted via phone, text, or email.Anything else we should know? Δ
