Purchaser(s) Full Name(s):

Street: Apt.#:

City:

State:

Zip:

Country:

Citizenship:

Home Phone: Best Time to Contact:    am    pm

Work Phone: Best Time to Contact:     am    pm

Cell Phone: Best Time to Contact:     am    pm

Fax:

           Please be sure to give you full and exact email address.

            Email:

Confirm Email:

Name of Salesperson:

I wish to purchase the following parcel(s):

Parcel #:    Group #:     Price:

Parcel #:    Group #:     Price:

Parcel #:    Group #:     Price:

Parcel #:    Group #:     Price:

Parcel #:    Group #:     Price:

Total purchase price for above parcel(s):

Optional - If financing is required...

1. State amount of financing required:

(Maximum amount financed = 75% of total purchase price).

2. The number of years you wish to finance: N/A 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

Note:
Thank you for completing the above form. Once you have verified the information is correct, click on the Submit button below and the form will automatically be transmitted to us. We will confirm the receipt of your Purchase Request Form within 72 hours either by email or phone... then guide you through the purchasing process.