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Quick Response Form

Tell us About You
Name*
First Last
Email*
Best Phone #
Best Time To Call
Time Zone
Property Details
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
The Property is Currently
Number of Bedroom
Number of Bath
Square Footage
Age of House
Garage
What is the current condition of the house?
Please list any needed repairs in this comment box
Check All That Apply
- Wood Floors
- Tile
- Carpet
- Laminate
- Formal Dining Room
- Bonus Room
- Finished Basement
- Unfinished Basement
- Stucco
- Brick
- Aluminum Siding
- Vinyl Siding
- Wood Siding
- Other Siding
- Privacy Fence
- Other Fence
- Central Heat
- Central Air
- Floor/Wall Furnace
- Wood Stove
- Fireplace
- Swamp Cooler
- Septic Tank
- Swimming Pool
- Slab
- Raised Foundation
- Roof Asphalt Shingle
- Roof Clay Tile
- Roof Concrete Tile
- Wood Shingle
- Other
Tell Us About The Numbers
1st Mortgage Balance
1st Mortgage Payment Amount
Does the 1st mortgage payment include taxes and insurance?
2nd Mortgage Balance
2nd Mortgage Payment Amount
Does the 2nd mortgage payment include taxes and insurance?
Any other mortgages on the property?
Monthly HOA Payment
What is the combined monthly Payment on all mortgages?
Are there any other liens and/or issues that may affect this property? If so, please explain.
Please Complete This Section
1st Mortgage
Dollar Amount Behind
Number of Payments Behind
2nd Mortgage
Dollar Amount Behind
Number of Payments Behinds
Other Mortgage
Total Dollar Amount Behind
Number of Payments Behind
Have you received a Notice of Default?
Has a Foreclosure Sale date been scheduled?
Sale Date
MM slash DD slash YYYY
Last Few Questions...
Is your property currently listed with a realty company?
If your property is currently list with a realty service, what is the listing expiration date?
Are you currently in bankruptcy?
How did you hear about us?
Referral Source
Please provide additional information that you feel is important for us to know.
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Email
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