Contact Information The only information we require on this form is your name and a way to contact you;
* First and Last Name:
* Address of Property for Sale:
* City, State and Zip Code:
E-mail Address:
Daytime Phone with Area Code:
Evening Phone with Area Code:
Cell Phone with Area Code:
* Are You The Owner?
If "No", Please list the Owners Name:
How Quickly Do You Need to Sell?
<- please choose ->
As Soon As Possible
2 weeks
4 weeks
1 – 2 months
2 months plus
no big hurry
Reason for Sale:
<- please choose ->
Divorce or
Separation
Foreclosure
Death in Family
Job Relocation
Financial Problems
Avoid Broker Fees
Speed Up
Selling Process
Probate
Tenant Problems
Inheritance
Bankruptcy
Health Issues
Property Condition
Need to Move Fast
Upsizing
Downsizing
Other
Property Information
* Property Type:
<- please choose ->
single family
condo
apartment building
townhouse
land only
farm
* Property or Home Condition:
<- please choose ->
Very Good
Good
Fair
Poor
* Estimated Value:
<- please choose ->
I don't know
Less than $30,000
$30,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000 - $300,000
$300,000 - $400,000
$400,000 - $500,000
$500,000 - 1
Million
More than 1 Million
<- please choose ->
How Much Would You Sell For If You Could Get a Fast
"All Cash" Sale Now?
Square Footage (if known):
Number of Bedrooms:
<- please choose ->
one
two
three
four
five
more than five
Number of Bathrooms:
<- please choose ->
one full
one and a half
two full
two and a half
three full
three and a half
four full
more than four
Stories:
<- please choose ->
one
two
split level
Age of Home:
<- please choose ->
less than 3 years
3 – 5 years
5 – 10 years
10 -15 years
16 – 20 years
21 – 30 years
31- 40 years
41 – 50 years
more than 50 years
Pool?
Is the Property Currently Occupied?
Are You Living in the Property?
Is the Property listed with a Realtor?
Mortgage Information
1st Mortgage Balance Estimate:
Monthly Payment:
Does first mortgage payment include: taxes and insurance?
How Many Payments Are You Behind?
None
One
Two
Three
Four or more
Do You Have a 2nd Mortgage or Home Equity Loan?
2nd Mortgage or Equity Loan Balance Estimate:
Other Notes or Comments
