How did you hear about us? Select... Postcard Referral Internet Flyer Sign Newspaper ad Business Card Class Attended Personal Contact Other

First Name: Last Name:

Address:

City: State: Select... Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Unspecified Zip:

Home Phone:

Cell Phone:

Work Phone:

Email Address:

Confirm Email:

What type of property? Select... Single Family Home Multi Family Home Townhome Condominium Land Mobile Home

What year was it built?

How many bedrooms? Select... 1 2 3 4 5 6 7 8 9 more than 9

How many baths? Select... 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 more than 8

Does it have a garage? Select... No 1 Car 2 Car 3+ Car 1 Car Carport 2 Car Carport

Does it have a pool? Select... Yes No

Does it have Central Heat/Air (CHA)? Select... Yes No

What is the heated square footage of the house?

What is the approximate lot size?

What is the construction type? Select... Block Frame Mobile Other

Who lives in the house? Select... Owner Tenant Vacant

How soon are you looking to move? Select... Immediately less than 1 month 1 to 3 months 3 to 6 months Greater than 6 months Just looking right now

What is your situation or reason for selling?

How much are you asking?  $

How did you get your price?

Does it need any repairs? Select... Yes No

If yes, list what type of repairs?

How much will the property appraise for today?  $

Would you allow us to purchase your house by allowing us
   to take over your payments? Select... Yes No

Who is the lender on the 1st Mortgage?

Type of mortgage? Select... Conventional Equity Line Adjustable Pay Option ARM Private FHA VA Other Not Sure

About what is owed on your 1st mortgage?  $

How many payments are you behind?

How much are your payments? $

Does payment include Taxes and Insurance? Select... Yes No

What is the interest rate?

Who is the lender on the 2nd Mortgage?

Type of mortgage? Select... Conventional Equity Line Adjustable Pay Option ARM Private FHA VA Other Not Sure

About what is owed on your 2nd mortgage?  $

How many payments are you behind?

How much are your payments?  $

Does payment include Taxes and Insurance? Select... Yes No

What is the interest rate?  % 

In the box below please include any other information that you feel will be helpful. For instance, extra amenities, neighborhood, additional mortgages, liens, judgements, bankruptcy, etc.