| First and Last Name: |
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| Address of Property for
Sale: |
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| City, State and Zip Code: |
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| E-mail Address: |
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| Daytime Phone with Area Code: |
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| Evening Phone with Area Code: |
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| Cell Phone with Area Code: |
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| Are You The Owner? |
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| If "No", Please list the
Owners Name: |
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| How Quickly Do You Need
to Sell? |
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| Reason for Sale: |
If "Other" please specify: |
| Property Type: |
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| Property or Home Condition: |
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| Estimated Value: |
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How Much Would You Sell For If You Could Get a Fast Sale Now? |
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| Square Footage (if known): |
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| Number of Bedrooms: |
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| Number of Bathrooms: |
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| Stories: |
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| Age of Home: |
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| Pool? |
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| Is the Property Currently Occupied? |
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| Is the Property listed with a Realtor? |
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| 1st Mortgage Balance
Estimate: |
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| Monthly Payment: |
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Does first mortgage payment include: taxes and insurance? |
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| How Many Payments Are You Behind? |
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Do You Have a 2nd Mortgage or Home Equity Loan? |
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2nd Mortgage or Equity Loan Balance Estimate: |
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Other Notes or Comments
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