EmailMe Form - Home Sale Consultation

Owner Name *

First Last

Co-Owner Name

First Last

Cell Phone Number *

### - ### - ####

Evening Phone Number

### - ### - ####

Email *

Property Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Is your mortgage currently late? *

Yes

No

Do you have a 2nd mortgage or Home Equity Line of Credit? *

Yes

No

Select mortgage company name(s): *

If Other, specify

Approximate mortgage balance: *

$ Dollars . Cents

Total all mortgages, HELOCs, etc.

Reason for home sale: *

I certify that the information contained in this form is accurate and that I am the owner of the property referenced as Property Address. I understand that any Home Sale Consultation information provided does not constitute legal advise. I authorize Lisa Rosser of Keller Williams Preferred Properties to contact me via phone, email and/or US Mail.

Do you agree? *

Yes, I agree.

Intial *