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Contact Information                                                                   (* denotes required fields) *First Name *Last Name *Address     *City *State Select... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming     *Zip Code     Format: 99999 Home Phone    Cell Phone     Format: 999-999-9999 Work Phone    E-mail address Property Information Property Type Select... Multi Family Home Single Family Home Mobile Home Townhome Condominium Land Commercial     Year built     Construction type Select... Frame Block Block/Frame Stucco Mobile Other Number of bedrooms Select... 1 2 3 4 5 6 more than 6    Number of bathrooms Select... 1 1.5 2 2.5 3 Garage Size Select... None 1 Car 2 Car 3 Car    Pool Yes No      Central Heat & Air Yes No Heated square footage     Approximate lot size Who lives in the home? Select... Owner Tenant Vacant    When do you need to move? Select... Immediately less than 1 month 1 to 3 months 3 to 6 months 6 months to 1 year Greater than 1 year Why are you selling?    What is your asking price? Does it need repairs? Yes No     What will the property appraise for? Would you be interested in having us take over your payments? Yes No Financial Information Who holds the first mortgage?    Mortgage type Select... Conventional Equity Line FHA VA Private Lender Other Approximate amount owed on mortgage    Interest Rate How much are your payments? How many payments behind? Do payments include Taxes and Insurance? Yes No Who holds the second mortgage?    Mortgage type Select... Conventional Equity Line FHA VA Private Lender Other Approximate amount owed on mortgage    Interest Rate How much are your payments? How many payments behind? Do payments include Taxes and Insurance? Yes No Comments

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