Home Information Form

Name *

First

Last

Phone Number *

-

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

How long have you lived In the house? *

Estimated value of your home? *

If we offered you quick cash and closed quickly, what would be the minimum amount you would take for the house? *

How much was the original loan for the house you are selling? *

What is the current loan balance on your home? *

What is your current monthly payment? *

Does your payment include taxes? *

Yes No

Does your payment include insurance? *

Yes No

Do you have any outstanding loans? *

Yes No

Are the loans current? *

Yes No

Are you willing to sell the house for what you owe? *

Yes No

Are you willing to recieve your equity in payments? *

Yes No

Why are you selling? *

How old is the house? *

What type of construction is the house? *

What type of roof is on the house? *

How many bedrooms? *

How many bathrooms? *

What is the approximate square footage of the house? *

Comment *

Does the house have a basement? *

Yes No

Is the basement finished? *

Yes No

Are there any Appliances being sold with the house, if so list: *

Is the house vacant or occupied? *

vacant occupied

If occupied, when will it become available (date): *

Does your house need repair? *

Yes No

In your opinion, what repairs are needed? *

Are you listed with a Realtor? *

Yes No

How did you hear about us? *

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