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C O N F I D E N T I A L
Your Contact Information
*Your First Name
*Your Last Name
*Your Email
*Day-time Phone Number
*Your Cell Phone
Your Street Number
Your Street Name
*Your Zip
Your City
Your State	... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming
* What's your situation? Why are you selling?
Property Information
Same as my home address above
Street Number
Street Name
Zip
City
State	... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming
What kind of repairs or maintenance does the house need?
How much do you think these repairs will cost?	$  e.g. 5000 (not 5,000)
Property Type	Single Family House Duplex TriPlex 4-Plex Multi-Family Commercial Property Land Other Multiple / Combo Townhome Condo Patio Home
Approx. Square Feet
Age of Home	10 - 15 years 16 - 20 years 21 - 30 years 3 - 5 years 31 - 40 years 41 - 50 years 5 - 10 years Less than 3 more than 50 years
Bedrooms	0 1 Studio 2 3 4 5
Bathrooms	0 1 1.5 2 2.5 3 3.5 4 4.5
Pool	Yes  No
Garage?	Yes  No
Is it Vacant?	Yes  No
Price And Terms
1st Mortgage  2nd Mortgage  3rd Mortgage  Balance  $  $  $ e.g. 5000 (not 5,000)  Monthly Payment  $ $   $ e.g. 5000 (not 5,000) Are Payments Current?   Yes  No   Yes  No   Yes  No
How much are your total annual property taxes?	$ e.g. 5000 (not 5,000)
Are your property taxes and insurance included in your monthly mortgage payment?	Yes  No
Do you pay Homeowner / Condo Association dues? If so, how much per year?	$ e.g. 5000 (not 5,000)
*How much are you asking us to pay for your house?	$ e.g. 5000 (not 5,000)
*If we were to have your house appraised, how much do you think it would be worth?	$
Would you sell your house for what you owe on it?	Yes  No  Undecided
Would you be willing to receive any of your equity, if applicable, in the form of monthly payments?	Yes  No  Undecided
Would you be willing to sell your house by allowing us to take over your monthly mortgage payments?	Yes  No  Undecided
* If we were able to buy your house in 7 Days or less, what is the least you could accept?	$  e.g. 5000 (not 5,000)
How did you hear about us?
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