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Personal Information
Name
First
Last
Street Address
City
State
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Zip/Postal Code
Day Phone
Evening Phone
Email
House Information
Number of Bedrooms
Bath
Square Footage
Approximate Age
How long have you owned the home?
Is the house
vacant
occupied
Are You Behind On Payments?
yes
no
If so, how many payments are you behind?
Has the bank began to foreclose?
yes
no
If so, when is the foreclosure sale date
Let's talk a little about the numbers..
1st Mortgage
Amount
1st Mortgage
Payment
2nd Mortgage
Amount
2nd Mortgage
Payment
Equity Line Amount?
Approximate Value of the Home
Is the house attached to a bankruptcy?
yes
no
Please describe condition of the house:
poor
fair
good
Is the house listed with a realtor?
yes
no
If yes, when does the listing expire:
Please describe any repairs that the house may need:
Please list any other comments:
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