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Attention: Builder or Builder Sales Agent

The bearer(s) of this form, named below, is/are exclusively represented in a Buyer-agent capacity
by the Indy Home Marketing Group, LLC an Indiana Real Estate Agency, Licensee Number
LC207000151.

Please register the potential home Buyer(s) as being represented by our company, and Fax a
copy of this form to our office within 24-hours of receipt.

The signature(s) of the potential Buyer(s), and/or signature of the Builder, or Builder sales agent,
on this document DO NOT constitute an obligation to purchase.

When the potential Buyer(s) is/are ready to enter into a contractual home purchase agreement,
a Indy Home agent will accompany the Buyer(s) to assist with the purchase in an advisory
capacity.


To be completed by Buyers


BUYER NAME(S) ____________________________________________________________________________


SIGNATURE(S)____________________________________________________________________________


BUILDER NAME: _______________________________________________ VISIT DATE: ___________________


To be completed by Builder


COMMUNITY / HOME LOCATION:________________________________________________________________


CITY______________________________________________________ ZIP CODE ________________________


BUILDER CONTACT PHONE ___________________________ E-MAIL __________________________________


AUTHORIZED BUILDER / SALES
REPRESENTATIVE SIGNATURE ________________________________________________________________


NOTE: To be valid, this form must be presented to the Builder, or Builder sales agent, on your
FIRST visit to a builder sales office! Please request a signed and dated copy from the Builder,
or Builder sales agent, for your record of registration.



Copyright 2007, All Rights reserved, Indy Home Marketing Group, LLC, Indianapolis, IN 46256