Fast Response Form

Following is our FAST response form. Fill out this form as completely as possible and we will promptly contact you to discuss your options.

For faster service call us direct!

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866-714-4650 extension 10

The information you provide on this form will remain confidential

Tell us about you...

Your name:

E-mail address:

Daytime phone:

Evening phone:

Best time to call:

Tell us about the property...

Property street address:

Property city and state:

Property zip code:

The Property is currently:

Bedrooms:

Baths:

Square footage:

Age of House:

Garage:

What is the general condition of the house:

Please describe any needed repairs in this box

Check all that apply...

Wood Floors

Formal Dining Room

Carpeting

Game Room

Tile

Fireplace

Finished Basement

Deck

Unfinished Basement

Swimming Pool

Privacy Fence

Other Fence

Brick

Vinyl Siding

Steel Siding

Wood Siding

Other Siding

Stucco

Central Heat

Central Air

Floor Furnace

Wood Stove

Septic Tank

Crawl Space

Slab

Storage Shed

Shop

Tell us about the numbers...

How much do you feel the property is worth:

1st mortgage balance:

1st mortgage payment amount:

Does the 1st mortgage payment include taxes and insurance:

Are there other mortgages on the property:

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:
If payments are current click here

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:

Has a foreclosure sale date been set:

Sale date:

Just a couple more questions...

Is your property currently listed with a real estate agent/broker:

If property "is" listed, when does your listing expire:

Are you currently in bankruptcy:

How did you hear about us:

Please provide any further comments that you feel are important in the box below...

Comments

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