Name:

Telephone (Day): (With Area Code)

Telephone (Evening): (With Area Code)

E-mail:

About the House You are Selling:

Address:

City:

State:

Zip:

The house is listed with a broker?
No Yes – For what amount? $

How many bedrooms?

How many baths?

Year Built?

Garage? (If yes, indicate how many cars?)
Yes – Cars: No

Any special information about the house?

Does the house need any work? Yes No

(If yes, what do you think needs to be fixed in the house?)

How much are you asking? $

If this house were to be appraised today, how much do you think it would appraise for?
$

What is the approximate balance on the mortgage(s)? $

What are the approximate monthly payments? $

Are you current with your payments? (If no, indicate how many payments are you behind?)
Yes No - Behind payments.

Would you sell the house for what you owe? Yes No

Would you take your equity in payments over a period of time? Yes No

If I would offer you all cash and close quickly, what's the least you would accept? $

Is this the best you could do?
Yes No – What is the best you could do? $

In other words, what you're telling us is if you don't get that price, you won't sell?
Yes, that's right. No, that's not true.

How did you hear about us?