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HOME PROPERTY INFORMATION FORM
First Name
*
Last Name
*
Email Address
*
Prefered Contact Phone
*
Alternate Phone
Work Phone
Property Address
*
City
*
State / Zip
*
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
/
Approx. Square Feet
*
Bedrooms/Bathrooms
*
1
2
3
4
5+
1
1.5
2
2.5
3
3.5
4+
Single or Double Wide Mobile Home?
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Single
Double
Will you consider financing your home?
*
-- Select --
No
Yes
Property Type
*
-- Select --
Mobile Home
House
Home Lot
Commercial Property
Acerage
Condition of home
*
-- Select --
Good
Normal
Rough
Home manufacturer.
Year home was built
Source of Value
-- Select --
Appraisal
Realtor CMA
Tax Value
Guess
Other
Asking Price
Asking Price for Cash
List Any Repairs
Why are you selling?
1st Mortgage:
Balance $
Interest
%
Payment $
2nd Mortgage:
Balance $
Interest
%
Payment $
Are you behind on your payments?
-- Select --
No
Yes
In Foreclosure
Amount Behind
How did you find us?
-- Select --
Google
Yahoo
Bing
Other Search Engine
Craig's List
Radio
TV
Print Ad
Word of Mouth
Billboard
Road Sign
Other
Notes
