First name    Last name 

Day phone    Eve phone 

Address of home             

City    State        Zip 

e-mail 

How much are you asking for your house? 
How much would it appraise for? 

When did you purchase the home? 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 or prior

Style of the property (cape, ranch, condo, multi, etc.) Cape Ranch Split level Colonial New Englander Condo Town House Duplex Multi-family Apartment building Land only Commercial Industrial Mixed use Other

How many bedrooms in the home? 

How many bathrooms? 

Approximately how many square feet is it? 

Description

Does it need repairs?  yes   no
If so, how much would the repairs cost?  

How much is owed on the mortgage?

Are the payments current or behind?  Current   Not current  

Does this number include taxes and insurance? yes   no