Name First, Last*:
Address of Property for Sale:
City:
State/Province:
Zip/Postal Code*:
Phone (Day Time)*:		()
2nd Phone number:		()
E-mail*:
Are you the Owner?		Yes
		No  If "No" please list the owners name:
How Quickly do you need to sell?		...please choose As Soon as Possible 2 weeks 4 weeks 1-2 months 2 months + no big hurry
Reason for selling:		...please choose Divorce or Seperation Foreclosure Death In Family Job Relocation Financial Problems Avoid Broker Fees Speed Up Selling Process Probate Tenant Problems Inheritance Bankruptcy Health Issues Property Conditions Need to Move Fast Upsizing Downsizing Other
		If "Other" Please Specify
Property		Information
Property Type:		...please choose Single Family Condo Apartment Building Townhouse Land Only Farm Commercial
Property Size Estimate		sq.-ft. acres
Property or Home Condition:		...please choose Like new Needs Minor Repairs Need Modorate Repairs Needs Major Repairs Unusable in current condition
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-$600,000 $600,000-$700,000 $700,000-$800,000 $800,000-$900,000 $900,000-$1,000,000 Greater Than $1,000,000
What's your asking price to sell right now?	$
How Many Bed Rooms?
How Many Bath  Rooms?		(Example: 2.5)
Approximate age or year built
Does it have::		Garage?	Pool?
Is the Property:		Currently Occupied?	Listed with an Agent?
Mortgage		Information
First Mortgage Balance Estimate:	$
Monthly Payments	$
Does the First Mortgage include Taxes and insurance:		Yes
		No
How many payments missed?		0 1 2 3 4+
Second Mortgage or Home Equity Loan Balance Estimate	$	Enter "0" if none
Monthly Payments	$	Enter "0" if none
How many payments missed?		0 1 2 3 4+
Other Notes or Comments