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Tell Us About You
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| First Name: |
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| Last Name: |
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Daytime Phone:
(include area code) |
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Evening Phone:
(include area code) |
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| Best Time To Call: |
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| Email: |
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| Best Method To Contact: |
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Tell Us About The Property
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| Property Address Street 1: |
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| Property Address Street 2: |
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| Property City: |
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| Property Zip Code: |
(5 digits) |
| Property State: |
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| Property Is Currently: |
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| Number of Bedrooms: |
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| Number of Bathrooms: |
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| Garage: |
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| Square Footage: |
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| Year Built: |
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| Lot Size: |
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| Condition of the Property: |
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| Describe Needed Repairs: |
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Check All That Apply
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| Wood Floors |
Formal Dining Room |
| Carpeting |
Game Room |
| Tile |
Fireplace |
| Finished Basement |
Deck |
| Unfinished Basement |
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 |
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Tell Us About The Numbers
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| How much do you feel the property is worth: |
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| 1st mortgage balance: |
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| 1st mortgage payment amount: |
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| Does the 1st mortgage payment include taxes and insurance: |
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| Are there other mortgages on the property: |
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| What is the combined balance of all mortgages: |
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| What is the combined monthly payment on all mortgages: |
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| Are all mortgage payments current: |
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| Additional Comments |
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If Payments Are Not Current, How Behind Are They
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First Mortgage
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| $Amount Behind: |
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| Number of Payments: |
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Second Mortgage
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| $Amount Behind: |
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| Number of Payments: |
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Other Mortgage
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| $Amount Behind: |
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| Number of Payments: |
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| Have You Received A Foreclosure Notice: |
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| Has a foreclosure sale date been set: |
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| Sale date: |
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A Few More Questions
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| Is your property currently listed with a real estate agent/broker: |
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| If property "is" listed, when does your listing expire: |
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| Are you currently in bankruptcy: |
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| How did you hear about us?: |
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| Please provide any further comments that you feel are important in the box below... |
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