Please provide the following contact information:

How did you here about us?	Business Card Handout Mail Newspaper Radio Word of Mouth Other
First Name *
Last Name *
E-mail *
Daytime Phone *
Evening Phone *
Best time to call:
Tell us about the property...
Property street address:
Property city and state:
Property zip code:
The Property is currently:	Owner Occupied Occupied by Renter Vacant
Bedrooms:	1 2 3 4 5 6+
Baths:	1 1.5 2 2.5 3 3.5 4+
Square footage:
Age of House:
Garage:	Please Select One Car Attached One Car Detached Two Car Attached Two Car Detached Carport None Other
What is the general condition of the house?	Please Choose Excellent Good Fair Poor UGLY!
Please describe any needed repairs in this box
Check all that apply
Wood Floors	Formal Dining Room
Carpeting	Game Room
Tile	Fireplace
Garage	Deck
Carport	Swimming Pool
Privacy Fence	Other Fence
Brick	Vinyl Siding
Steel Siding	Wood Siding
Other Siding	Stucco
Central Heat	Central Air
Floor Furnace	Wood Stove
Septic Tank
Crawl Space	Slab
Storage Shed	Shop
Tell us about the numbers...
How much do you feel the property is worth:
1st mortgage balance:
1st mortgage payment amount:
Does the 1st mortgage payment include taxes and insurance:	Select Yes No
Are there other mortgages on the property:	Select Yes No
What is the combined balance of all mortgages:
What is the combined monthly payment on all mortgages:
Please tell us about any other liens and/or other title problems that may affect this property by typing an explanation here.
Are all mortgage payments current: If payments are current click here	Select Yes No
If payments are not current, how far behind are they?
1st mortgage $ Amount behind # of payments 2nd mortgage $ Amount behind # of payments Other mortgage $ Amount behind # of payments
Have you received a foreclosure notice:	Select Yes No
Has a foreclosure sale date been set:	Select Yes No
Sale date:
Just a couple more questions...
On the scale below, please let us know what is more important to you, time (how quickly you sell the house) or money (extracting the maximum value from your house)
TimeMoney
Is your property currently listed with a real estate agent/broker?	Select Yes No
If property "is" listed, when does your listing expire?
Are you currently in bankruptcy?	Please Select No Yes - Chapter 7 Yes - Chapter 13
How did you hear about us?	Referral from Attorney Referral from CPA Referral from Friend Referral from Realtor Newspaper Postcard Letter Car sign or bumper sticker Small roadside sign Billboard Television commercial Radio commercial Internet search engine Link from other Internet site Other
Please provide any further comments that you feel are important in the box below...
Comments

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