Name:
*
Address:
*
City:
*
State:
*
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code:
*
Phone:
*
Email Address:
*
Information About Your Property
Type of Property
Choose A Type
Single Family Home
Condo/Townhome
2-4 Unit Multi-family
5+ Unit Multi-family
Other
Approx Condition:
Perfect
Good
Fair
Needs Work
Poor
Bedrooms
--
0
1
2
3
4
5
6
6+
Bathrooms:
--
1
1.5
2
2.5
3
3.5
4
4+
Basement
None
Full Un-finished
Full Finished
Partial Un-finished
Partial Finished
Look-out Un-finished
Look-out Finished
Walk-out Un-finished
Walk-out Finished
Partial Un-finished + Crawl
Partial Finished + Crawl
Crawlspace
Garage
None
Attached 1 car
Attached 2 car
Attached 3+ car
Detached 1 car
Detached 2 car
Detached 3+ car
Approx Sq Footage:
Your Loan Details
1st Mortgage
Bank & Amount
2nd Mortgage
Bank & Amount
Are You Behind
on Payments?
Yes
No
Please list any additional details about your home or situation that you would like me to know about.
Features: