FAST ACTION FORM
Please fill out the form below as completely as you can. A representative will contact you shortly to review your options.
Tell us about yourself...
* Your First Name:
* Your Last Name:
E-mail Address:
Daytime Phone:
(Please include area code)
Evening Phone:
(Please include area code)
Best Time To Call:
Tell us about the property...
Property Street Address:
Property City:
Property State:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
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Nevada
New Hampshire
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New Mexico
New York
North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Property Zip:
The Property is Currently:
Please select
Owner Occupied
Occupied by Renter
Vacant
No. of Bedrooms:
<1
1
2
3
4
5
5+
No. of Baths:
<1
1
2
3
4
5
5+
Square Footage:
Age of House:
Garage:
Please select
One Car Attached
One Car Detached
Two Car Attached
Two Car Detached
Carport
None
Other
General Condition of the House:
Please select
Excellent
Good
Fair
Poor
UGLY!
Please describe any repairs needed:
Check all that apply...
Wood Floors
Formal Dining Room
Carpeting
Game Room
Tile
Fireplace
Finished Basement
Deck
Unfinished Basement
Swimming Pool
Privacy Fence
Other Fence
Brick
Vinyl Siding
Steel Siding
Wood Siding
Other Siding
Stucco
Central Heat
Central Air
Floor Furnace
Wood Stove
Septic Tank
Crawl Space
Slab
Storage Shed
Shop
Tell us about the numbers...
How much do you feel the property is worth:
1st mortgage balance:
1st mortgage payment amount:
Does the 1st mortgage payment include taxes and insurance:
Yes
No
Are there other mortgages on the property:
Yes
No
What is the combined balance of all mortgages:
What is the combined monthly payment on all mortgages:
Please tell us about any other liens and/or other title problems that may affect this property by typing an explanation here:
Are all mortgage payments current:
If payments are current
click here
Yes
No
If payments are not current, how far behind are they?
First
mortgage
Dollar Amount Behind:
Number of payments:
Second
mortgage
Dollar Amount Behind:
Number of payments:
Other mortgage
Dollar Amount Behind:
Number of payments:
Have you received a Foreclosure Notice:
Yes
No
Has a foreclosure sale date been set:
Yes
No
Unknown
Sale Date:
(mm/dd/yyyy)
Just a couple more questions...
Is your property currently listed with a real estate agent/broker
Yes
No
If property is listed when does your listing expire:
Are you currently in bankruptcy:
Yes
No
How did you hear about us:
Please select
Referral from Attorney
Referral from CPA
Referral from Friend
Referral from Realtor
Local Newspaper
Postcard
Letter
Internet search engine
Link from other Internet site
Other
Please provide any further comments that you feel are important in the box below:
