* Your First Name:  

* Your Last Name:  

* Email Address:  

Day Time Phone:
(Please include area code)

Evening Phone:
(Please include area code)

Best Time To Call:

Property street address:

Property city:

Property state:

Property Zip:

The Property is currently: Owner Occupied Occupied by Renter Vacant

No. of Bedrooms: less than 1 1 2 3 4 5 5+

No. of Baths: less than 1 1 2 3 4 5 5+

Square Footage:

Age of House:

Garage: One Car Attached One Car Detached Two CarAttached Two Car Detached Carport None Other

What is the general condition of the house: Excellent Good Fair Poor UGLY!

Please describe any needed repairs in this box:

Wood Floors     Carpet     Tile     Finished Basement     Unfinished basement

Privacy Fence     Brick     Steel Siding     Other Siding     Central Heat    

Floor Furnace     Septic Tank     Slab     Shop     Formal Dining Room    

Game Room     Fireplace     Deck     Swimming Pool     Other Fence    

Vinyl Siding     Wood Siding     Stucco     Central Air     Wood Stove

Crawl Space     Storage Shed

How much do you feel the property is worth:

1st mortgage balance:

1st mortgage payment amount:

Does the 1st mortgage payment include taxes and insurance: Yes No

Are there other mortgages on the property: Yes No

What is the combined balance of all mortgages:

What is the combined monthly payment on all mortgages:

Please tell us about any other liens and/or other title problems that may affect this property by typing an explanation here:

Are all mortgage payments current:
If payments are current click here Yes No

$ Amount Behind:

# of payments:

$ Amount Behind:

# of payments:

$ Amount Behind:

# of payments:

Have you received a foreclosure notice: Yes No

Has a foreclosure sale date been set: Yes No Unknown

Sale Date:

Is your property currently listed with a real estate agent/broker: Yes No

If property is listed when does your listing expire:

Are you currently in bankruptcy: Yes No

How did you hear about us: Referral from Attorney Referral from CPA Referral from Friend Referral from Realtor Local Newspaper Postcard Letter Internet Search Engine Other

Please provide any further comments that you feel are important in the box below: