First Name:*

Last Name:*

Address:*

City:*

State:*

Zip:*

Phone:*

Fax:

Email:*

Month you are relocating: Select January February March April May June July August September October November December

Year: 2006 2007 2008 2009 2010 2011 2012

Number of people in your family who are relocating: 1 2 3 4 5 6+

Number in your family under 18: 1 2 3 4 5 6+

Age of Head of Household: under 25 25-34 35-44 45-54 55-64 65+

Occupation: clerical/sales manufacturing distribution professional services manager/executive homemaker government student retired other

Combined household income: <$25,000 $25,000-$35,000 $35,000-$50,000 $50,000-$75,000 >$75,000

Reason for Relocation:





Job transfer
Starting new business
Family
Returning to area
Attend or teach school
Retire

Other

If you are returning to the area, please explain why:

Can your story be used for marketing purposes: yes/no yes no

Do you plan to: Buy Rent Rent short-term

If you are purchasing a home or condominium, what price range are you considering? <$60,000 $60-90,000 $91-150,000 $151-225,000 >$225,000

I would like further information about:












Arts & Entertainment
Hoopeston Area Visitors Guide
Historic Sites
Hoopeston Area Brochure
Parks & Recreation
Employment
Schools (public, private, other)
Healthcare
Activities/Events
Real Estate
Demographics

Other