Name

Address of home you want to sell

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

FAX

E-mail

What's the size of your house (sq. ft):

How much is your house worth:

How do you know that?:

How much do you owe on your house: (total owed including all mortgages and liens)

How many mortgages on the house:

Are there any other liens or judgements:

Have you tried to sell your house:                           Select One YES. I listed it with an agent YES. by owner only NO. I haven't actively tried to sell it

What is the condition of your house:   (what needs to be fixed to get full market value)                       Select One Perfect (I've taken really good care of it) Normal wear and tear but no damage Minor Damage (cosmetic/paint/carpet) Major Damage (structural/roof/floor/flood/fire)

How bad is your situation:                                       Select One Not too bad yet. But I have no equity I'm behind a few payments I'm facing foreclosure I'm considering bankruptcy Not bad at all. Just looking to sell. I have equity.

Have you received a Notice of Default (NOD)?   And if so, How long ago?:

What is your main concern right now:                      Select One Saving my credit (or what's left of it) Loosing my home Being able to move on

What do you need to be able to move on:                 Select One Nothing. Just get me out of this house I'm going to need less than $10k                                 I'm going to need more than $10k

How soon do you need to act on this:                       Select One Immediately Within 30 days Within 60 days There's no rush

How much is you monthly  1st mortgage payment:

How much is you monthly 2nd mortgage payment:

How much is your association fee if any:

If behind in payments, how much:

How much money do you need right now:

Is you home occupied or vacant:                               Select One Occupied Vacant

Best time to contact you:                                              Anytime Morning (8a-12p)                                                                    Afternoon (12p-6p) Night (6p-10p)

How did you hear about us:                                         Select one Craigslist Ad Newspaper Ad Search Engine Street Sign Referral (please mention this when we contact you) Tear Flyer Other

Who referred you?

Please give us any additional information that can help us find a solution for you