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| Name |
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| Email Address |
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| Phone Number |
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| Address of Property: |
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| City: |
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| State: |
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| Zip Code: |
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| County: |
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| Bedroom/Bath/Garage: |
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| Square Footage: |
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| Stories: |
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| Exterior: Brick, Vinyl Siding, etc : |
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| How long have you owned your house?: |
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| Repairs needed and cost: |
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| Are you currently using a Realtor?: |
Yes
No |
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| How long have you had it listed?: |
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| How fast do you need to sell your property?: |
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| Describe your current situation: |
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| Current Mortgage left on the property: |
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| Monthly Payment: |
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| Does this payment include taxes, insurance, etc.?: |
Yes
No |
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| Are you behind on your payments?: |
Yes
No |
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| If you are behind, how many months?: |
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| Are you in the foreclosure process and need our help by buying your house?: |
Yes
No |
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| What is the foreclosure date?: |
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| Back Taxes, Liens, Bankruptcy? Explain: |
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| Would you be open to using creative real estate techniques to relieve you of your situation? (i.e. taking over payments, short sale with the bank, paying you monthly payments if you own your house free & clear, etc.): |
Yes
No |
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| Extra Comments: |
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| How would you like us to contact you |
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| How did you hear about us |
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