First Name(s):*		Day Phone:*	- -
Last Name:*		Evening Phone:	- -
Email:*		Cellular/Pager:	- -
		Best time to call:	Day Evening

Do you need to sell your house fast?			Yes No
What's your situation: Why are you selling?
How soon do you need to move? Please Select 0-1 Month 2-3 Months 4-6 Months 6 Months - 1 Year

Address:
City:
State:	Select AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida FC - Foreign Country GA - Georgia GU - Guam, US Territory HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan AE - Military(AE) AP - Military(AP) MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon NA - Other Country PA - Pennsylvania PR - Puerto Rico RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennesee TX - Texas UT - Utah VT - Vermont VI - Virgin Islands VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming
Zip:
County:
Bedrooms			Stories/Floors:
Bathrooms:			Garage(s)
Square Footage:			Basement:
Year Built:
Lot Size/Acres:
How long have you owned this house?
What is the current condition of your property?			Excellent Good Fair Poor
What kind of repairs and maintenance does the house need?
How much do you think these repairs will cost?			$
Is the house occupied?			Yes No
Is the house currently listed with a Realtor?			Yes No
If yes, how long has the property been listed?
When will the listing expire?			/ /
If no, has the house been previously listed?			Yes No

How much are you asking for the house?			$
How did you determine your asking price?
How much do you think the house is conservatively worth?				$
1st Mortgage
	Balance:$		Payment:$	Interest Rate:%
				Fixed
Payments Current? Yes No				Adjustable
2nd Mortgage	Balance:$		Payment:$	Interest Rate:%
				Fixed
Payments Current? Yes No				Adjustable
3rd Mortgage	Balance:$		Payment:$	Interest Rate:%
				Fixed
Payments Current? Yes No				Adjustable
If no, how far behind?
How much are your total annual property taxes?				$
Are your property taxes and insurance included in your monthly mortgage payment?				Yes No
Do you pay Homeowner/Condo Association dues? If so, how much monthly?				$
Would you sell your house for what you owe on it?				Yes No
Would you be willing to receive any of your equity, if applicable, in the form of monthly payments?				Yes No
Would you be willing to sell your house by allowing us to take over your monthly mortgage payments?				Yes No
If we were able to buy your house in 2 weeks or less, what is the least you would accept?				$
Do you have any questions or comments you would like to share with us?
Thank you for taking the time to take advantage of our offer for assistance. We understand that this is a difficult time. We will review your information as quickly as possible and will contact you shortly with information that we anticipate will be a win-win for both of us.