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?

Yes
No

If "No", Please list the Owners Name:

How Quickly Do You Need to Sell?

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

If "Other" please specify:

Property Type:

single family condo apartment building townhouse land only farm

Property or Home Condition:

Very Good Good Fair Poor

Estimated Value:

I don't know Less than $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

How Much Would You Sell For If You Could Get a Fast Sale Now?

Square Footage (if known):

1500 sq. ft or less 1500 to 2500 sq. ft. 2500 to 3500 sq. ft. 3500 to 4500 sq. ft. 4500 to 5500 sq. ft. more than 5500 sq. ft. I Don't know the amount

Number of Bedrooms:

one two three four five more than five

Number of Bathrooms:

one full one and a half two full two and a half three full three and a half four full more than four

Stories:

one two split level

Age of Home:

less than 3 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?

Yes
No

Is the Property listed with a Realtor?

Yes
No

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