Information Request Form Thank You for your interest in Naomi Pines Real Estate. To better serve your needs, please fill out the following Information request form. You can also contact us by email at jim@naomipines.com or call us at (570)-646-5555.
	Name:
	Address:
	City:
	State :	Zip:
	Home Phone :
	Work Phone :
	Fax # :
	Email :
	I prefer to be reached by :	Choose One Phone Email Fax
	I am interested in buying :	Choose One A Home A Lot Other
	Price Range :
	Location :	Choose One Lake Naomi Timber Trails Lake Naomi & Timber Trails Pinecrest Lake Arrowhead Lakes Locust Lake Other Undecided If Other:
	Desired Style of Home:
	Number of Bedrooms:
	Number of Baths :
	Garage :	Choose one Yes No Undecided
	Will it be a primary or vacation home :	Choose one Primary Vacation Other
	Additional Requested Items:
	Comments / Questions: