Tell Us About You
First Name
Last Name
Email Address
Phone Number
Daytime Phone Number
Alternate Number
Best Time to Call
What is your role in this deal?
Wholesaler
Agent
Seller
Buyer
JV Partner
Bird Dog (Referral)
Other (Please specify)
Tell Us About The Property
Street Address
City
State
Zip Code
This property is currently
- Owner occupied
- Occupied by a tenant
- Vacant
- Other
No of bedrooms
No of bathrooms
Sq Ft
Garage
- One car: attached
- One car: detached
- Two cars: attached
- Two cars: detached
- Carport
- None
- Other
What is the general condition of the house?
- Excellent
- Good
- Fair
- Poor
- UGLY!!
Please describe the repairs
Check all that apply
Check all that apply Check
Wood Floors
Carpeting
Tile
Finished Basement
Check all that apply Check
Formal Dining Room
Game Room
Fireplace
Deck
Check all that apply Check
Unfinished Basement
Privacy Fence
Brick
Steel Siding
Check all that apply Check
Swimming Pool
Other Fence
Vinyl Siding
Wood Siding
Check all that apply Check
Other Siding
Central Heat
Floor Furnace
Septic Tank
Check all that apply Check
Stucco
Central Air
Wood Stove
Crawl Space
Check all that apply Check
Slab
Shop
Check all that apply Check
Storage Shed
Let's Talk Numbers
How much do you feel the property is worth?
1st mortgage balance:
1st mortgage monthly payment amount:
Does the 1st mortgage payment include taxes and insurance:
Yes
No
Are there other mortgages on the property:
Yes
No
What is the combined balance of all mortgages:
What is the combined monthly payment on all mortgages:
Please tell us about any other liens and/or other title problems that may affect this property by typing an explanation here:
Are all mortgage payments current:
Yes
No
If payments are not current, how far behind are they
1st Mortgage
$ Amount Behind:
# of payments:
2nd Mortgage
$ Amount Behind:
# of payments:
Other Mortgage
$ Amount Behind:
# of payments:
Have you received a foreclosure notice:
Yes
No
Has a foreclosure sale date been set:
Yes
No
Unknown
Sale Date:
Just a couple more questions
Is your property currently listed with a real estate agent/broker
Yes
No
If property is listed when does your listing expire:
Are you currently in bankruptcy:
Yes
No
How did you hear about us:
Referral from Attorney
Referral from CPA
Referral from Friend
Referral from Realtor
Local Newspaper
Postcard
Letter
Internet search engine
Link from other Internet site
Other
Please provide any further comments that you feel are important in the box below:
Submit Form