Please note that all fields followed by an asterisk must be filled in. First Name*
First Name*
Last Name*
Last Name*
E-mail Address*
E-mail Address*
Day Phone*
Day Phone*
Evening Phone Cell Phone Best time to call*
Best time to call*
---Select--- \nMorning
Afternoon
Evening
Weekend
Anytime
Property Address*
Property Address*
City*
City*
State*
State*
Zip Code*
Zip Code*
Have you received a Notice of Default Letter - meaning you are in foreclosure?*
Have you received a Notice of Default Letter - meaning you are in foreclosure?*
---Select--- \nYes
No
Don't Know
# of Bedrooms*
# of Bedrooms*
---Select--- \n1
2
3
4
5
6
7
8
9
10 or more
# of Bathrooms*
# of Bathrooms*
---Select--- \n1
1.5
1.75
2
2.5
2.75
3
3.5
3.75
4
Square Footage
---Select--- \n<1000 sq ft
1001 - 1250 sq ft
1251 - 1500 sq ft
1501 - 2000 sq ft
2001 - 2500 sq ft
2501 - 3000 sq ft
3001 - 4000 sq ft
4001 - 5000 sq ft
5001 or more sq ft
Lot Size
---Select--- \n< 5,000 sq ft
5,001 - 10,000 sq ft
10,001 - 15,000 sq ft
.25 - .50 acre
.51 acre - .99 acre
1.00 - 4.99 acres
5 - 10 acres
10 - 20 acres
20 or more acres
Year Built How long have you owned this house? What is the current condition of the property?
---Select--- \nPoor
Fair
Good
Excellent
What kind of repairs or maintenance does the house need? Please explain. How much do you think these repairs will cost? Is there anyone living in the house?
---Select--- \nYes - owner
Yes - tenant
No - vacant
Is the house currently listed with a Realtor? If yes, when does the listing expire? Balance of 1st Mortgage?*
Balance of 1st Mortgage?*
Interest Rate for 1st Mortgage? Fixed or Adjustable Rate? Monthly Payment for 1st Mortgage Are Payments Current on 1st Mortgage? If No, How Far Behind in Payments? Balance on 2nd Mortgage? Interest Rate on 2nd Mortgage? Fixed or Adjustable Rate? Monthly Payment for 2nd Mortgage? Are Payments Current on 2nd Mortgage? If No, How Far Behind in Payments? Are your property taxes and insurance included in your monthly mortgage payment?*
Are your property taxes and insurance included in your monthly mortgage payment?*
---Select--- \nYes
No
Don't Know
How much are your annual property taxes? Do you pay Homeowner's Dues or Condo Association Dues? If so, how much per year?*
Do you pay Homeowner's Dues or Condo Association Dues? If so, how much per year?*
If we were to have your house appraised today, how much do you think it would be worth? Please tell us a little about your situation and how you would like our help?*
Please tell us a little about your situation and how you would like our help?*
