Name Age City State Country Email Phone Please contact me by Select E- Mail Phone Have you been to Costa Rica before Yes / No --- What is your knowledge of Costa Rica Select A little A lot None Do you speak Spanish Yes / No --- If not will you learn Yes / No State of health Need hospital facilities close Yes / No State sporting activities such as Golf, Fishing, Tennis, Hiking, Bird watching etc Do you need high speed internet Yes / No Do you need a church close Yes / No --- Denomination Do you have a profession or service that you would be willing to volunteer to the community Yes / No You're interest is in Select Land only Land and structure Investment land B&B or similar Other (see comments) --- Geographic Preference Select Quepos Dominical Escaleras Uvita Coronado Peninsula Osa Ballenas Golfito Pto Jimenez Mata Palo Just in the southern zone Other (specifiy) I prefer this type Select Walk to beach Ocean view Beach front Other (specify) Type of property Select Gated community Land only Something constucted Condo Other (see comments) How many months will you spend in Costa Rica annually? Select 1 2 3 4 5 6 8 9 10 11 12 Visitors at one time Select 1 2 3 4 more Bedrooms Select 1 2 3 4 more Will you rent when not there Yes / No I want to purchase in Select immediately 1 month 2 months see comments --- My level of interest is Select very high high medium low just_looking My budget is Select $50,000 $75,000 $100,000 $150,000 $180,000 $200,000 $250,000 $300,000 $350,000 $400,000 $450,000 $450,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 see comments --- Financing Select $40% down 50% down Cash Use_self directed_IRA If I see something I really like, I can arrange for a deposit Yes / No My arrival date is Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2006 2007 Percentage of trip to be used for property investigation % Do you need information on the use of self directed IRA's for offshore investment Yes / No Do you need mortgage information relative to foreign purchasers Yes / No METHOD OF VIEWING PROPERTIES I want you to set up the some time so I may see all properties that fit my criteria and prepare an agenda Please recommend Hotels and Tours that would be of interest to me Note: Those seeking property in the southern zone must be aware of how quickly the property is selling and therefore if our associates advise you to act if you like something, please do not construe this as pressure. ORIENTATION I would like to take advantage of the one on one orientation meeting when I arrive. I am not in a position to buy this trip. Please propose an agenda to orient me, an outline of what I will be seeing along with the cost of the tour. COMMENT BOX FOR MORE DETAILS: