New Page 1

HTML Form Page:

 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:  
Has a foreclosure sale date been set:  
Sale Date:  
Are you currently in bankruptcy:  
 Property Information
Property street address:  
Property city:  
Property state:  
Property Zip:  
The Property is currently:  
No. of Bedrooms:  
No. of Baths:  
No. of Floors:  
Basement:  
Construction:  
Square Footage:  
Lot Size:  
Year Built:  
Garage:  
Pool:  
Subdivision:  
How long have you lived in house? 
Condition of the house:  
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?
Are there any other liens and/or other title problems:  
Is your property currently listed with a real estate agent/broker:  
If property is listed when does your listing expire:  
Was your property previously listed with a real estate agent/broker:
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:  
1st Mortgage Interest Rate: 
Fixed Rate or Adjustable:  
Are the loan payments current: 
$ Amount Behind:  
# of payments:  
  Other Mortgages? Click Here
 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 provide any further comments that you feel are important in the box below:  
CAPTCHA Image
Change Image
Write the characters in the image above
New Page 1