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Fill out the information below and the Jack Keller Inc. staff will be happy to notify you as soon as an accessible property comes on the market.


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Email
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Name
Address
City
State
Zip
Cell Phone#
Phone#
When are you looking to purchase? approx.
What area are you most interested in?
What is your minimum price range?
What is your maxium price range?
Do you need a fully accessible home?
 No  Yes 
How many bedrooms would you prefer?
How many bathrooms would you prefer?
Are you service connected? (Military)
 No  Yes 
If your service connected, do your qualify for the VA grant?
 No  Yes 
If your service connected and your qualify for the VA grant, have you used it?
 No  Partially  Yes 
Do you need a roll-in shower?
 No  Yes 
What is the nature of your disability?
Can you transfer?
 No  Yes 
Please describe your dream home.



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