Name: *
E-mail: *
Phone: *
Address: *
City: *
State: *	AL AK AR AZ CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip code:
Why are you selling?
Are there any loans outstanding?	Yes No
What is/are the balance(s)?
Is/Are the loan(s) assumable?	Yes No
Is/Are the loan(s) current?	Yes No
If late, by how many months?
If we could offer you quick cash and close quickly, what would be the minimum you would accept?
Does the house need repair?	Yes No
In your opinion, how much repair is needed?
Please describe what repairs are needed:
How many bedrooms and bathrooms?
What is the approximate square footage?
What is the construction?
What is approximate age of house?
What type of roof?
How long have you owned this house?
Is the house vacant or occupied?	Vacant Occupied
What is the address of the property you are selling?
What is the current mortgage payment(s)?
If the house was appraised tomorrow, what do you think it would appraise for?
When do you want to move?