| Contact Information |
| First Name: | |
| Last Name: | |
| Address Street 1: | |
| Address Street 2: | |
| City: | |
| Zip Code: | (5 digits) |
| State: | |
| Daytime Phone: | |
| Evening Phone: | |
| Email: | |
| Tell us about the property |
| Property strret address: | |
| Property city and state: | |
| Property zip code: |
|
| The Property is currently: | |
| Age of House: | |
| Baths: | |
| Bedrooms: | |
| Square Footage: | |
| Garage: | |
| What is tghe general condition of the house? | |
| Property Type: | |
| Occupancy: | |
| Check all the apply |
| Wood Floors | Formal Dining Room |
| Carpeting | Game Room |
| Tile | Fireplace |
| Finished Basement | Deck |
| Unfinished Basement | Swimming Pool |
| Privacy Fence | Other Fence |
| Brink | Vinyle Siding |
| Steel Siding | Wood Siding |
| Other Siding | Stucco |
| Central Heat | Central Air |
| Floor Furance | Wood Stove |
| Septic Tank | |
| Crawl Space | Slab |
| Storage Shed | Shop |
| Financial Information |
| Loan Type: | |
| Loan Amount: | (USD) |
| Purchase Price: | (USD) |
| Appraised Value: | (USD) |
| Mortgage Balance: | (USD if applicable) |
| 1st mortage |
|
| 2nd mortage: | |
| Other mortage: | |
| Have you recieved a foreclosure notice? | |
| Has a foreclosure sale date been set?: | |
| Sale Date: | |
| Other Information |
| |
