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Your Contact Information
*
Your First Name:
*
Your Last Name:
*
E-mail Address:
Day Time Phone:
Evening Phone:
Cell Phone:
Best Time To Call:
Tell Us About Your Situation
Do you need to sell your house Fast?
Why are you looking to sell?
How soon are you needing to move?
Have you received a foreclosure notice:
Please select
Yes
No
Has a foreclosure sale date been set:
Please select
Yes
No
Unknown
Sale Date:
Are you currently in bankruptcy:
Please select
Yes
No
Property Information
Property street address:
Property city:
Property state:
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Property Zip:
The Property is currently:
Please select
Owner Occupied
Occupied by Renter
Vacant
No. of Bedrooms:
<1
1
2
3
4
5
5+
No. of Baths:
<1
1
2
3
4
5
5+
No. of Floors:
<1
1
2
2+
Basement:
Please select
No
Yes
Construction:
Please select
Brick
Siding
Both
Square Footage:
Lot Size:
Year Built:
Garage:
Please select
One Car Attached
One Car Detached
Two Car Attached
Two Car Detached
Carport
None
Other
Pool:
Please select
No
Yes
Subdivision:
How long have you lived in house?
Condition of the house:
Please select
Excellent
Good
Fair
Poor
UGLY!
Please list any repairs in this box:
Estimated Appraisal Value:
Annual Property Taxes:
Are there Home Owners or Condo Association dues? If so what are they?
Please select
Yearly
Monthly
Are there any other liens and/or other title problems:
Is your property currently listed with a real estate agent/broker:
Please select
Yes
No
If property is listed when does your listing expire:
Was your property previously listed with a real estate agent/broker:
Please select
Yes
No
How much do you feel the property is worth:
How did you determine this number?
1st Mortgage
1st Mortgage Balance:
1st Mortgage Payment Amount:
Does this payment include taxes and insurance:
Please select
Yes
No
1st Mortgage Interest Rate:
Fixed Rate or Adjustable:
Please select
Fixed Rate
Adjustable
Unknown
Are the loan payments current:
Please select
Yes
No
$ Amount Behind:
# of payments:
Other Mortgages? Click Here
2nd Mortgage
2nd Mortgage Balance:
2nd Mortgage Payment Amount:
2nd Mortgage Interest Rate:
Fixed Rate or Adjustable:
Please select
Fixed Rate
Adjustable
Unknown
Are the loan payments current:
Please select
Yes
No
$ Amount Behind:
# of payments:
Other mortgage
Other Mortgage Balance:
Other Mortgage Payment Amount:
Other Mortgage Interest Rate:
Fixed Rate or Adjustable:
Please select
Fixed Rate
Adjustable
Unknown
Are the loan payments current:
Please select
Yes
No
$ Amount Behind:
# of payments:
Additional Info
Would you sell your house for what you owe on it?
Yes
No
Undecided
Would you be willing to receive any of your equity, if applicable, in the form of monthly payments?
Yes
No
Undecided
Would you be willing to sell your house by allowing us to take over your monthly mortgage payments?
Yes
No
Undecided
If you were to sell quickly, what is the least you can sell your house for?
How did you hear about us:
Please select
Referral from Attorney
Referral from CPA
Referral from Friend
Referral from Realtor
Local Newspaper
Postcard
Letter
Internet search engine
Link from other Internet site
Other
Please provide any further comments that you feel are important in the box below:
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