First Name     Last Name

    Actual Property Address

   Address

        City      State    Zip

   Phone           Cell Phone  

   Email           Work Phone  

•    Bedrooms   1BR  2BR  3BR  4BR  5BR6BR+
•    Bathrooms  1Bath  2Bath  3Bath  4Bath  5Bath+     
•    1/2 Bath      None1Half 2Half   3Half  
•    Approximate Square Ft.       
•    What is the House Worth?  $
•    Source ?   Select Tax Card Realtor Opinion Appraiser Guess Other
•    What is your asking Price?  
•    Is your Property Listed with an Agent? Yes No
•    How Long have you owned the House?

Please provide some details about your Home Mortgage Loan(s) with Current Balance,etc.

•   Are the Payments Current? Yes No       How much in arrears?
•   Are The Taxes current?       Yes No          Taxes in arrears?    
•   How soon do you need to Move?
•   Is the House Vacant/Occupied?  Vacant Occupied 
•   Can you sell your house for what you owe on it? Yes No  
•   Can you sell if we take over your monthly mortgage payments? Yes No   
•   Does the House need Repairs?  Yes No 

 If yes, please provide repair details...

Why are you selling?

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