Please fill all information out completley as possible.  All lines marked with an * (asterisk) are REQUIRED information. All infomation that you provide is kept confidential and will NOT be provided to anyone nor be sold or made available to anyone but representatives of our company to work with you.

A representative will contact you via e-mail immediatly upon submission of your information to confirm that we received your questionnaire.  You will then be contacted via telephone after full review of the information you provided.

Confidential 
Personal Information

*Title:

Mr.Mrs.Ms.Miss.Dr.

*First Name:

*Last Name:

*Email Address:

*Your Address:

*City/Town:

*State:

ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

*Zip Code:

(5 digits)

Mobile/Pager:

 123 456-7890

*Daytime Phone:

 123 456-7890

*Evening Phone:

 123 456-7890

*When can we call you?

MorningAfternoonEveningNight 

*Tell us your situation. Why are you selling?:

*Do you need to sell your house fast?

Yes No

All entries marked with a '*' are required before submission

Property Information

*Property Address:

*City/Town:

*State:

ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

*Zip Code:

(5 digits)

County:

*Bedrooms:

12345678910+SELECT>

*Bathrooms:

11.522.533.54+  (.5=no tub/shower)

*Total Rooms:

234567891011121314151617181920More Than>21

*Floors/Stories:

*Style Of House:

*Basement:

NoneApartmentCrawl SpaceFinishedFullHalfPartially FinishedUnfinishedWalkoutOther

Year Built:

   (if known)

Square Footage:

 sq.ft. (ex 2300)

*Lot Size/Acres:

 ex(56'x110')or(2.3ac)

*Garage:

None1 Car Attached1 Car Detached1 ½ Car Attached1 ½ Car Detached2 Car Attached2 Car Detached2 ½ Car Attached2 ½ Car Detached3 Car Attached3 Car Detached3 ½ Car Attached3 ½ Car Detached4 Car Attached4 Car Detached5+ Car Attached5+ Car DetachedCarportOther

Pool:

Above GroundIn Ground

*Do you own the property?:

YesNo

  =>If YES, How Long?:

 (years,mos)

        =>If NO, explain:

*What is the condition of the house?:

ExcellentGoodFairPoorTerrible

*What repairs / maintenance does the house need?:

*How much would it cost?:

*Is anyone living in the house?:

Yes - Owner OccupiedYes - Tennant(s)No - Vacant

*How long has the property been for sale?:

*Is the house currently listed with a ®Realtor?:

Yes No

   => If YES,when does it expire?:

 All entries marked with a '*' are required before submission

Financial Information

*How much are you asking?:

*How did you arrive at that amount?:

AppraisalTax AssessmentRealtor/CMAInternetComparablesGuess/What I want

If your house/property were to be professionally appraised, what value do you think it would be?:

$

*Would you sell your house for what you owe on it?

Yes No Undecided

*Would you be willing to receive any of your equity, if applicable, in the form of monthly payments?

Yes No Undecided

*Would you be willing to sell your house by allowing us to take over your monthly mortgage payments?

Yes No Undecided

*If we were able to buy your house/property in 9 days or less, what is the least you would accept?:

*Does that mean if you don't get your price, you won't sell?:

All entries marked with a '*' are required before submission

Is there any information you'd like to provide?:

Do you have any questions or comments you'd like to share with us?:

*How did you hear about us?: