How did you hear about us? Select... Billboard Sign Business Card Drive By Flyer Foreclosures Daily Internet Letter Magnetic Sign Newspaper ad Other Postcard Radio Referral Signs TV Commercial

First Name: Last Name:

Address:

City: State: Select... Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Unspecified Zip:

Home Phone:

Cell Phone:

Work Phone:

Email Address:

Confirm Email:

What type of property? Select... Commercial Condominium Land Mobile Home Multi Family Home Single Family Home Townhome

What year was it built?

How many bedrooms? Select... 1 2 3 4 5 6 7 8 9 more than 9

How many baths? Select... 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 more than 8

Does it have a garage? Select... No 1 Car 2 Car 3+ Car 1 Car Carport 2 Car Carport

Does it have a pool? Select... Yes No

Does it have Central Heat/Air (CHA)? Select... Yes No

What is the heated square footage of the house?

What is the approximate lot size?

What is the construction type? Select... Block Block/Frame Frame Mobile Other Stucco

Who lives in the house? Select... Owner Tenant Vacant

How soon are you looking to move? Select... Immediately less than 1 month 1 to 3 months 3 to 6 months Greater than 6 months Just looking right now

What is your situation or reason for selling?

How much are you asking?  $ 

How did you get your price?

Does it need any repairs? Select... Yes No

If yes, list what type of repairs?

What is the After Repair Value (ARV)?  $ 

Would you consider owner financing? Select... Yes No

Who is the lender on the 1st Mortgage?

Type of mortgage? Select... Conventional FHA Equity Line Private Lender VA Not Sure Other

About what is owed on your 1st mortgage?  $ 

How many payments are you behind?

How much are your payments?  $ 

Does payment include Taxes and Insurance? Select... Yes No

What is the interest rate?  % 

Who is the lender on the 2nd Mortgage?

Type of mortgage? Select... Conventional FHA Equity Line Private Lender VA Not Sure Other

About what is owed on your 2nd mortgage?  $ 

How many payments are you behind?

How much are your payments?  $ 

Does payment include Taxes and Insurance? Select... Yes No

What is the interest rate?  % 

Lock Box Code:

Is it ok to display Lock Box on public website? Select... Yes No

Sales Rep Name/#:

Showing Instructions: Select... Drive by, call for appt Vacant, on lock box

In the box below please include any other information that you feel will be helpful. For instance, extra amenities, neighborhood, additional mortgages, liens, judgements, bankruptcy, etc.