Cutomer Survey Form

Full Name: *
State / Province / Region *
Telephone Number:
E-mail address: *
Please re-enter your email address: *
Have you been to Panama before? *	Yes No
Do you currently own property in Panama? *	Yes No
Are you looking for retirement property? *	Yes No
Are you looking for an investment property? *	Yes No
Are you looking for beach front/ beach view property? *
Are you looking for land only or something with a house already constructed? *
What size of property are you looking for? *
How big an investment would you like to make? *
When are you planning on visiting Panama? *
Will you require travel arrangement assistance? Hotel, Transportation, etc. *
Please, provide any additional information to help us better meet your needs. *
How did you hear about us? *
Were you refered to us by another organization or individual? *