Contact Information
Name   Day Phone Evening Phone
Email Address   How did you hear about us?
If Other, Where?  
Property Identification
Street Address  
Zip Code  
Subdivision (if any)  
Financial Information
How much do you owe on your property?  
How much is the property worth?  
1st Mortgage Holder   1st Mortgage Payment 1st Mortgage Balance
2nd Mortgage Holder   2nd Mortgage Payment 2nd Mortgage Balance
Do you have an equity line on this property?   Yes No
Equity Line Holder   Equity Line Payment Equity Line Balance
Total Monthly Payment on this property  
Are the payments current?   Yes No
If no, how far behind?  
# of pmts/months
$ amount
Penalties/fees included?
1st Mortgage  
Yes No
2nd Mortgage  
Yes No
Equity Line  
Yes No
Have you received a foreclosure warning letter from your lender?   Yes No
Have you received a notice of Foreclosure?   Yes No
Has a Foreclosure Sale Date been set?   Yes No
If Yes, what is the date?  
Is the property attached to a bankruptcy?   Yes No
Is the property   Occupied Unoccupied
Does the property need repairs?   Yes No
If Yes, please describe the repairs needed  
Total estimated cost of repairs    
Property Description
Ranch 2-Story Split Foyer Split Level       Sq. Footage
All Brick Brick Siding Wood Siding Vinyl/Aluminum Siding Stucco   Lot Size
                      Age of Roof
# of Bedrooms # of Baths Formal Living Room Formal Dining Room        
Fireplace Ceiling Fans                
Crawl Space Slab Finished Unfinished Partial    
Garage Carport On-Street Off-Street # of Cars    
Sewer Septic                
Central Air # of Units     Fenced in Backyard Pool    


What year was the property built?  
How long have you owned the property?  
Is the property listed with a real estate agent?   Yes No
If yes, when does the listing expire?  
Why do you want to sell?