First Name (required)

Last Name (required)

Day Phone (required)

Evening Phone (required)

Email (required)

Property Information

Address (required)

City (required)

State (required)

Zip Code (required)

Why are you selling your home? (required)

Bedrooms(required)

Bathrooms (required)

Square Footage (required)

Garage (required)

Basement (required)

Lot Size Acreage (required)

Year Built (required)

Construction (required)

How long have you owned this house?: (required)

What is the current condition of the property?: (required)

What kind of repair maintenance does the house need?:

How much do you think these repairs will cost?: (required)

Is there anyone living in the house?:

Is the Property currently listed for sale?

Is the house currently listed with a realtor?:

If yes, when does the listing expire?:

If no, has the house been previously listed?:

Personal Information

1st Mortgage Balance :

1st Mortgage Payment :

1st Mortgage Interest Rate:

Fixed or Adjustable? :

Payments Current:

If No, how far behind?:

2nd Mortgage Balance :

2nd Mortgage Payment :

2nd Mortgage Interest Rate:

Fixed or Adjustable? :

Payments Current:

If No, how far behind?:

3rd Mortgage Balance :

3rd Mortgage Payment :

3rd Mortgage Interest Rate:

Fixed or Adjustable? :

Payments Current:

If No, how far behind?:

How much are your total annual property taxes?:

Are your property taxes and insurance included in your monthly mortgage payment?:

Do you pay Homeowner/Condo Association dues?:

If so, how much per year?:

Comments (required)

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