Contact Information
Name
Phone number
Fax number
Email address
Best time to contact you

Property Information
Type of propertySingle Family
Townhouse
Condominium
Villa
Duplex
Vacant Land
Other
StyleRanch
2-Story
Split-Level
1.5 Story
Tri-Level
Other
Number of bedrooms1
2
3
4
5+
Number of bathrooms1
1.5
2
2.5
3
3.5
4
5+
GarageAttached 1 car
Attached 2 car
Attached 3+ car
Detached 1 car
Detached 2 car
Detached 3+ car
Carport
None
Square footage of home
Property Address
Property City
Zipcode

Financial Information
Do you currently have a mortgage?Yes
No
What is your current 1st mortgage balance? (appx.)
What is your monthly payment?
Are taxes & insurance included in this payment? Yes
No
Do you have a 2nd mortgage?Yes
No
What is your current 2nd mortgage balance? (appx.)
What is your monthly payment?
Are you behind on payments?Yes
No
About to be
Are you willing to sell for what you owe?Yes
No
Maybe
Will you allow us to take over your payments?Yes
No
Maybe
Why are you selling?

Helpful Information
How soon would you like to sell?Immediately
Within 1 month
Within 3 months
Within 6 months
Within 1 year
Undecided
Do you need to find a new home?Yes
No
How soon would you like to meet?
How did you hear about us?Yard sign
T.V.
Newspaper
Website Search
Direct Mail
Past Cleint
Other
Comments
All information provided will be kept strictly confidential