| Contact Information |
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| Primary Owner's First Name : |
* |
| Primary Owner's Last Name : |
* |
| Co-Owner First Name : |
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| Co-Owner Last Name : |
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| Street Address : |
* |
| Street Address2 : |
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| City : |
* |
| State : |
* |
| Zip : |
* |
| Primary Phone : |
* |
| Home Phone : |
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| Work / Cell Phone : |
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| Fax : |
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| Email : |
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| How did you find us? |
* |
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| Please, Tell Us About Your Property |
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| Property Type? |
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| Number of Bedrooms? |
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| Number of Bathrooms? |
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| Garage Type? |
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| Square Feet? |
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| Lot Size? |
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| Year Built? |
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| Describe repairs needed : |
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| How much would you spend to make your property perfect? |
$ |
| What do you think the house is worth "AS-IS"? |
$ |
| How did you arrive at this number? |
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| How do you rate the As-Is quality of the house? |
[10: perfect ; 0: demolished] |
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| Please, Tell Us About Your Situation |
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| Mortgage #1 : |
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| Lender : |
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| Loan Type : |
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| Balance : |
$ |
| Payment : |
$ |
| Amount to bring current : |
$ |
| Mortgage #2 : |
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| Lender : |
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| Balance : |
$ |
| Payment : |
$ |
| Amount to bring current : |
$ |
| Mortgage #3 : |
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| Lender : |
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| Balance : |
$ |
| Payment : |
$ |
| Amount to bring current : |
$ |
| Liens (all) : |
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| Balance : |
$ |
| Payment : |
$ |
| Amount to bring current : |
$ |
| Taxes (all) : |
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| Balance : |
$ |
| Payment : |
$ |
| Amount to bring current : |
$ |
| How would you rate your credit? |
[10: perfect ; 0: none] |
| Have you received notice of foreclosure? |
Yes No |
| Has a sale date been set? (mm/dd/yyyy) |
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| Have you filed for bankruptcy? |
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| What is your bankruptcy status? |
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| Who is living in the house? |
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| Listed with Realtor until when? |
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| Why hasn't your house sold? |
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| How quickly do you want to sell? |
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| Do you have another place to live? |
Yes No |
| HOW can we help solve your problem? |
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* required fields |
