Name

Day Phone

Evening Phone

Email Address

How did you hear about us?

If Other, Where?

Let's talk about the numbers... Property Identification

Street Address
City
State
Zip Code
Subdivision Name (if any)
How much do you owe on your property?
How much is the property worth?

1st Mortgage
Balance*

1st Mortgage
Payment*

1st Mortgage Holder

2nd Mortgage
Balance

2nd Mortgage
Payment

2nd Mortgage Holder

Do you have an equity line on this property?

Balance

Payment

Holder

So the total monthly payment is

Are the payments current? yes no

If no, how far behind? (If you don't know for sure, can you estimate?)

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1st Mortgage

# of pmts/months

$ amount

Penalities/Fees included?
yes no

2nd Mortgage

yes no

Equity Line

yes no

Date received

Have you received a foreclosure warning letter from your lender?

yes no

Have you received a Notice of Foreclosure?

yes no

Has a Foreclosure Sale Date been set?

yes no

If yes, what is the sale date?

Is the property attached to a bankruptcy? yes no

Are there any other comments you have that would enable us to help you better?

Is the property occupied unoccupied

Does the property need repairs? yes no

If "yes," what kind?

Describe your property...

Ranch

2-Story

Split
Foyer

Split
Level

Sq. Footage

All
Brick

Brick
Siding

Wood
Siding

Vinyl
Siding

Stucco

Lot Size

# of Bedrooms

# of
Baths

Formal
Living Rm

Formal
Dining Rm

Fireplace

Ceiling
Fans

Fenced

Pool

Sewer

Septic

Crawl
Space

Slab

Basement

Finished

Age of Roof

Unfinished

Central Air

Number of Units

	Garage		On-Street Parking		Number of Cars
	Carport		Off-Street Parking		Number of Cars

When was the property built?

How long have you owned the property?

Is the property listed with a real estate agent? yes no

If yes, when does the listing expire?

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