First Name * :
Last Name * :
Address of Property for
Sale:
City, State and Zip Code:
E-mail Address * :
Daytime Phone with Area Code * :
Evening Phone with Area Code:
Cell Phone with Area Code:
Are You The Owner?
If "No", Please list the
Owners Name:
How Quickly Do You Need
to Sell?
As Soon As Possible
2 weeks
4 weeks
1 - 2 months
2 months plus
no big hurry
Reason for Sale:
<- please choose ->
Divorce or
Separation
Foreclosure
Death in Family
Job Relocation
Financial Problems
Avoid Broker Fees
Speed Up
Selling Process
Probate
Tenant Problems
Inheritance
Bankruptcy
Health Issues
Property Condition
Need to Move Fast
Upsizing
Downsizing
Other
Property Information
Property Type:
single family
condo
apartment building
townhouse
land only
farm
Property or Home Condition:
Very Good
Good
Fair
Poor
Estimated Value:
I don't know
Less than $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000 - $300,000
$300,000 - $400,000
$400,000 - $500,000
$500,000 -
1 Million
More than 1
Million
How Much Would You Sell For If You
Could Get a Fast Sale Now?
Square Footage (if known):
Number of Bedrooms:
one
two
three
four
five
more than five
Number of Bathrooms:
one full
one and a half
two full
two and a half
three full
three and a half
four full
more than four
Stories:
one
two
split level
Age of Home:
less than 3
3 - 5 years
5 - 10
years
10 -15 years
16 - 20
years
21 - 30
years
31- 40 years
41 - 50
years
more than 50
years
Pool?
Is the Property Currently Occupied?
Is the Property listed with a Realtor?
Mortgage
Information
1st Mortgage Balance
Estimate:
Monthly Payment:
Does first mortgage payment include:
taxes and insurance?
How Many Payments Are You Behind?
None
One
Two
Three
Four or more
Do You Have a 2nd Mortgage or Home Equity
Loan?
2nd Mortgage or Equity Loan Balance
Estimate:
Other Notes or Comments
