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Fill out the information below as thoroughly as possible and click submit. It will be instantly routed to a property buyer who will be able to evaluate your property to see how we can help you with your house problem.

* Denotes a required field.

Client Contact Information
   
* Name
 
* Home Phone
 
* E-Mail Address
 
Work Phone
 
Mobile Phone
 
Best Time to Call or Meet
 
* House Street Address
 
* City
 
* State
 
* Zip Code
 
How did you hear about us?
 


Your House Information
First Mortgage Balance  
First Mortgage Payment  
First Mortgage Holder  
Are payments current?   Yes No
If "No", number of months behind  
     
     
     
Total Amount Owed  
Total Monthly Payment  
     
Second Mortgage Balance  
Second Mortgage Payment  
Second Mortgage Holder  
Are there any liens or equity lines against the house?   Yes No
If "Yes", Balance  
Payment  
Holder  
     
     
What do you think your house is worth
 
How did you come up with this figure
 
Please list any major and minor repairs needed to your house, if any
 
Total money needed for your house
 
If I can get you all CASH in 7 days what is the absolute lowest price you would be willing to accept for your house
 
Is the house vacant or occupied
  Vacant Occupied
Is this house listed with a realtor
  Yes No
If "Yes", date listing agreement expires
 
List anything else that would be important for us to know now before we come out and evaluate your property
 
     
 

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