Filling out this form is the quickest way to find out how we can help you.
All information is strictly confidential and is not shared with any other sources.

First Name:	*
Last Name:
Phone:	*
Mobile Phone:
Email Address:
Property Information
Address:
City:
State:
When was the house built?:
How long have you owned the house?:
Type of House	Select One Single Story Two Story Split Level Townhouse Other
Size (SqFt)
Foundation	Select One Slab Wood Basement
Exterior Finish	Select One Stucco Brick/Block Wood Other
Roof Type	Select One Shingle Shake Tile
Bedroom	Select One 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom 5 Bedroom 6 Bedroom Other
Baths	Select One 1/2 Bath 1 Bath 1.5 Bath 2 Bath 2.5 Bath 3 Bath 3.5 Bath 4 Bath Other
Garage	None 1 Car Carport 2 Car Carport 1 Car Garage 2 Car Garage 3 Car Garage >3 Car Garage
Condition	Select One Excellent Good Needs Minor Repairs Poor Unlivable
Is the property occupied?
YES NO
Is the property listed with a Realtor?
Yes No
If YES when does the listing expire?
Financial Information:
How much do you owe on the house?:
How much is the house worth?:
1st Mortgage Blance:
1st Mortgage Payment:
Interest Rate:
1st Mortgage Holder:
2nd Mortgage Balance:
2nd Mortgage Payment:
Interest Rate:
2nd Mortgage Holder:
Do you have a line of equity on this property?
Balance:
Payment:
Interest Rate:
Holder:
Are Payments Current?
YES - My payments are current NO - My payments are not current
If NO how far behind?
Number of payments/months:
Amount $:
Have you received a warning letter or Foreclosure notice from your lender?
YES NO
Is the house attached to a bankruptcy?
YES NO
How soon do you need to sell? Is there anything else we should know about the property or your situation? Additional comments:	*