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Your contact information:
Full Name:	* required
Title:	Owner Co-owner Other
Email Address:	* required
Home Phone Number:	* required
Cell Phone Number:	* required
Best time to call:	Anytime Morning Afternoon Evening
Your situation:
How quickly do you need to sell?	As soon as possible 2 weeks 4 weeks 1 - 2 months 2 months and above
What is your situation? Why are you selling?
Do you need to sell your home fast?	Yes No
The property is currently:	Owner Occupied Renter Occupied Vacant
If you live in the property, how soon do you need to move?
Your property information:
Are you interested in selling more than one property?	No Yes
Full Property Address?
Property Type?	Single Family Home Condominium Townhouse Vacant Land Duplex Triplex Fourplex Apartment Building Farm
Is this property your:	Primary Residence Second Home Investment Property Other
If you are renting this property out to a tenant, what is the current monthly rent amount?
Bedrooms:	1 2 3 4 5 6+
Bathrooms:	1 1.5 2 2.5 3 4+ 3.5
Approx. Square Footage:
Garage:	None Carport 1 2 3 4+
Stories:	1 2 3 Split Level
Amenities (check all that apply):	Master Bathroom Whirlpool Tub Living Room Hardwood Floor Dining Room Family Room Office Room Fireplace(s) Eat In Kitchen Laundry Room View Granite Countertop Pool/Spa RV/Boat parking
Any other upgrades or remodeling?
Approx. Year Built:
Basement:	None Apartment Crawl Space Finished Partially Finished Unfinished Walkout Other
Approx. lot size (sqf):
Are you the owner?	Yes No
If “Yes”, how long have you owned this house?
List of everyone on the title:
What is the current condition of your property?	Excellent Good Fair Poor
What kind of repairs and maintenance does the house need?
How much do you think these repairs will cost?
How long has the property been for sale?	Less than 2 weeks 2-4 weeks 4-8 weeks 2-4 months 5 + months
Is the property currently listed with a Realtor®?	No Yes
If "Yes", when does the listing expire?	Within 30 Days Within 60 Days Within 90 Days More Than 90 Days
If "No", the property:	has not been listed in the last 6 months listing expired 30 days ago listing expired at least 60 days ago listing expired more than 90 days ago
If you/your Realtor have been actively marketing your property, why do you think it has not sold?
Price and Terms:
How much are you asking us to pay for your property?	* required
How did you determine your asking price?	Appraisal Realtor Tax Assessment Best Guess Comparable Sales in the Neighborhood It is what I owe
If we were to have your house appraised, how much do you think it would be worth?	* required
What do you think the fair market value of your home would be if it were in perfect condition?	* required
If we could offer you cash and close quickly, what is the least you would accept?	* required
Would you be willing to sell your house by allowing us to take over your monthly mortgage payments?	Yes Yes, but I also need cash now Maybe, I have not thought about that, tell me more No N/A, no loans on the property
Would you be willing to receive any of your equity, if applicable, in the form of monthly payments?	Yes Yes, but I also need cash now Maybe, I have not thought about that, tell me more No
If you answered yes to either of the last two questions, how much cash do you need now?
If we were to buy your house FOR ALL CASH within 7 days, what is the least you would accept?
Would you sell your house for what you owe on it?	Yes No Undecided
If we guarantee your payments until your home is sold, would you consider leasing us your home?	Yes No Undecided
Existing loans, liens and other obligations on the property:
Are there any loans outstanding on the property?	Yes No
If yes, what is the approximate total amount of ALL loans outstanding on the property?
If there are any other liens on the property, what is the approximate total amount?   (Include tax, creditor, mechanics liens and judgments, etc.)
Please tell us about the other liens and/or other title problems that may affect this property:
1st mortgage balance (approx.):
1st mortgage monthly payment:
1st mortgage interest rate:
Is the rate fixed or adjustable?	Fixed Adjustable
Are the payments current?	Yes No
If "No", how far behind?
2nd mortgage/equity line of credit balance (approx.):
2nd mortgage/equity line of credit monthly payment:
2nd mortgage/equity line of credit interest rate (approx.):
Is the rate fixed or adjustable?	Fixed Adjustable
Are the payments current?	Yes No
If "No", how far behind?
3rd mortgage/equity line of credit balance (approx.):
3rd mortgage/equity line of credit monthly payment:
3rd mortgage/equity line of credit interest rate (approx.):
Is the rate fixed or adjustable?	Fixed Adjustable
Are the payments current?	Yes No
If "No", how far behind?
How much are the total annual property taxes?
Are the property taxes current?	Yes No
If not, what is the approximate total amount of taxes and penalties due?
Are property taxes and insurance included in the monthly mortgage payment?	Yes No
Do you pay Homeowner/Condo Association dues? If so, how much per year?
Have you received a foreclosure notice?	Yes No
Has a foreclosure sale date been set?	Yes No
If a sale date has been scheduled, what is the date?
Are you currently in bankruptcy?	No Yes, in chapter 7 Yes, in chapter 13
If in bankruptcy, when did you file?
If in a chapter 13 bankruptcy, are the payments under the plan current?	Yes No
Do you have any questions or comments you would like to share with us?