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Your Full Name
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Best contact number
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Alternate number
Best time to reach you
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E-mail address
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How did you hear about us?
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Postcard
TV Ad
Radio
Web Search
Letter
Flyer
Business Card
Friend or Referall
Other
Style of house
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Single - Stand Alone House
Twin - Attached on one side
Row - Attached on both sides
Multi - 2 Units
Multi - 3 Units
Multi - 4+ Units
Don't Know/Other
Property street address
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City
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State
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Zip Code
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Approx amount of 1st mortgage (if any)
approx monthly payments on 1st (if any)
Approx amount of 2nd mortgage (if any)
approx monthly payments on 2nd (if any)
Reason for Selling
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Are you behind on payments?
*
Yes
No
How many months if Applicable
One Month or Less
1-3 Months
3-6 Months
6-9 Months
9+ Months
How fast do you want to sell?
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1-7 Days
2 Weeks
3-4 Weeks
1-2 Months
6+ Months
Just Shopping Around
Is your property listed with a realtor?
*
Yes
No
How long have you owned it?
Number of Bedrooms
1
2
3
4
5
6-9
9+
Number of Bathrooms
1
1.5
2
2.5
3
3.5
4
4.5
5+
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