Full Name   

    Other Name(s) On Deed or Mortgage  

    Best  daytime Phone number    

    Best evening Phone number       Alternate Phone

    Property address   

    City        State        Zip   

    Email address   

    Are You the Owner    yes No

    Best time to call    Morning Noon Afternoon Evening                 Where did you hear about us?    Smart Shopper The Gazette Door hanger Sign Flyer Referred by someone internet search

    Do you need to sell Fast ?   yes            How soon do you need to move?   

    Tell us about your Situation. Why are you selling?

    Type Of Property?    Single Family Duplex Multifamily Land Farm Condo     Number Of Acres?        Condition Of Property?    Very Good Good Fair Poor

       Style of House?        Number of Bedrooms?         # of Baths   

   Please Check all that apply:  Garage    Pool    Hot Tub

   What repairs are needed?

     Estimated Value   $ I do not no $75,000-$100,000 $100,000-$120,000 $120,000-$140,000 $140,000-$160,000 $160,000-$180,000 $180,000-$200,000 $200,000-$250,000 $250,000-$300,000 More than $300,000     How much would you sell it for, if you could get a Fast sale Now?   $

    How would you like us to help you?    

    Is the Property listed with a realtor?    yes no     Asking Price?

    On a scale of 1-10 with 10 being the highest, What would you rate your motivation level?