Please complete as much of the requested information below as possible. The more information we have, the better able we are to serve your needs.

Contact Information
First Name:
Last Name:
Address:
City:
State:
Postal/Zipcode:
Home (Evening) Phone:
Email Address:
Work (Day) Phone:
Cell:
Fax:
Questions for the Home Seller
What are you asking for the house?:
What do you think your house will appraise for if it were in tip-top shape?:
Why are you selling:
Is the house listed?:	Yes     No
How did you arrive at your asking price?:
Does the house need any repairs?:	Yes     No
Approximate Cost?:
Will you sell for what you owe?:	Yes     No
Property Information
Property Address:
City:
State:
Postal/Zipcode:
What area is it in?:
How Many Bedrooms:	Select 1 2 3 4 5 6+
Bathrooms?:	Select 1 1.5 2 2.5 3 3.5 4 4.5 5.5 6 6.5 7+
Square Footage:
Lot Size:
Construction:	Frame Brick Block Stucco Other
Air Conditioning:
Garage:	Select 0 1 2 3 4
Carport:	Yes      No
Basement:	Yes      No
Appliances:	Refrigerator Range Dishwasher
Is the house vacant?:	Yes     No
Mortgage Information
What do you owe on the first mortgage?:
Who is the lender?:
Interest rate:
Monthly Payment:
What do you owe on the second mortgage?:
Who is the lender?:
Interest rate:
Monthly Payment:
Are your payments current?:	Yes     No
If behind by how many months or years:
Other Questions
How did you hear about us?:
Comments:
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