Fast Response Form

Name

Email

Phone

Best Time To Call

Full Address of Property

Number of Bedrooms

Number of Bathrooms

Square Footage

Age of House

Is there a garage? If so, how many cars?

What is the general condition of the house? What is the general condition of the house? Excellent Good Fair Poor

Please describe any needed repairs in this box

Check all that apply Check all that apply Wood Floors Carpeting Tile Finished Basement Formal Dining Room Game Room Fireplace Deck Unfinished Basement Swimming Pool Privacy Fence Other Fence Brick Vinyl Siding Steel Siding Wood Siding Other Siding Stucco Central Heat Central Air Floor Furnace Wood Stove Septic Tank Crawl Space Slab Shop Storage Shed

How much do you feel the property is worth?

1st mortgage balance

Are there other mortgages on the property?

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 not current, how far behind are they?

Is your property currently listed with a real estate agent/broker?

If property is listed when does your listing expire?

Are you currently in bankruptcy?

How did you hear about us?

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