Your Contact Information
*
First Name(s)
*
Day Phone
*
Last Name
*
Evening Phone
*
Email
*
Cellular/Pager
*
Preferred contact
...select one
Email
Day Phone
Evening Phone
Cell Phone
Pager
*
Best Time To Call
As soon as possible
7 am - 9 am
9 am - 12 noon
2 pm - 5 pm
7 pm - 9 pm
Email Only Please
Your Situation
*
Do you need to sell your house
fast
?
Yes
No
*
If so, what is our situation? Why are you selling?
Your Property Information
*
Address
*
City
*
State
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
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KY
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MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
Zip
*
Bedrooms
...select
1
2
3
4
5
6
7 or more
*
Stories/Floors
*
Bathrooms
...select
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6 or more
*
Garage
...select
None
Carport
1 Car
1 & 1/2 Car
2 Car
2 & 1/2 Car
3 Car
3 & 1/2 Car
4 Car
4 & 1/2 Car
5+ Car
*
Sq. Footage (approx)
...select
< 600 sq ft
700 sq ft
800 sq ft
900 sq ft
1000 sq ft
1100 sq ft
1200 sq ft
1300 sq ft
1400 sq ft
1500 sq ft
1600 sq ft
1700 sq ft
1800 sq ft
1900 sq ft
2000 sq ft
2250 sq ft
2500 sq ft
2750 sq ft
3000 sq ft
3250 sq ft
3500 sq ft
4000 sq ft
5000 sq ft
6000 sq ft
7000 sq ft
8000 sq ft
9000 sq ft
10000 sq ft
12500 sq ft
15000 sq ft +
*
Basement
...select
None
Crawl Space
Finished
Full
Half
Partially Finished
Unfinished
Other
*
Age of House
...select
< 2 years
2 - 5 years
5 - 10 years
10 - 15 years
15 - 25 years
25 - 50 years
50+ years
*
Lot Size/Acreage
*
Construction
...select
brick
vinyl
wood siding
stucco
brick w/vinyl
other
*
How long have you owned the house?
*
What is the current condition of your property?
Excellent
Good
Fair
Poor
Terrible
Condemned
*
What kind of repairs does the house need?
*
How much do you think the repairs will cost?
*
Is there anyone living in the house?
...select one
Yes - Owner Occupied
Yes - Tenant
No - Vacant
*
How long has the property been for sale?
months
*
Is the house currently listed with a Realtor?
Yes
No
If Yes, when does the listing expire?
If No, has the house been previously listed?
Yes
No
Price & Terms
*
How much are you asking us to pay for your house?
$
*
How did you determine your asking price?
Appraisal
Realtor
Tax Assessment
Best Guess
Comparables
*
If we were to have your house appraised, how much
do you think it would be worth?
1st Mortgage
2nd Mortgage
3rd Mortgage
Balance
$
$
$
Payment
$
$
$
Interest Rate
%
Fixed
ARM
%
Fixed
ARM
%
Fixed
ARM
Payments Current ?
Yes
No
If No, How far behind?
$
*
How much are your total annual property taxes?
$
*
Are your property taxes included in your monthly mortgage payments?
Yes
No
*
Would you sell our house for what you owe on it?
Yes
No
U
ndecided
*
Would you be willing to receive any of your equity, if applicable, in the form of monthly payments?
Yes
No
U
ndecided
*
Would you be willing to sell your house by allowing us to take over your monthly mortgage payments?
Yes
No
U
ndecided
*
If I could offer you quick cash and close within 10 days or less, what would be the least you would accept?
$
*
How did you hear about us?
*
Do you have any questions or comments you would like to share with us?
Please Click Only Once
C O N F I D E N T I A L
Thank you for taking the time to share your home with us.
We will review your information and contact you shortly.
If you have any problem submitting this form, please
contact us
and let us know.
C O N F I D E N T I A L
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