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C O N F I D E N T I A L
Your Contact Information
*Your First Name
*Your Last Name
*Your Email
*Your Cell Phone
* What's your situation? Why are you selling?
*When do you need to sell your house?
Property Information
*Street Number
*Street Name
*Zip
*City
*State	... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming
*Is the house currently listed with a ®Realtor?	Yes  No
If Yes, when does the listing expire?	January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 mm/dd/yyyy
* If No, has the house been previously listed?
* What kind of repairs or maintenance does the house need?
How much do you think these repairs will cost?	$  e.g. 5000 (not 5,000)
*Property Type	Single Family House Duplex TriPlex 4-Plex Multi-Family Commercial Property Land Other Multiple / Combo Townhome Condo Patio Home
*Bedrooms	0 1 Studio 2 3 4 5
*Bathrooms	0 1 1.5 2 2.5 3 3.5 4 4.5
*Is it Vacant?	Vacant Owner Occupied Tennant Occupied
Price And Terms
1st Mortgage * Balance  $ *Are Payments Current?   Yes  No *If Not How Far Behind?  $
*Are Property Taxes Current?	Yes  No
*If Not How Far Behind?
*How much are you asking us to pay for your house?	$ e.g. 5000 (not 5,000)
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