Fast Response Form

Following is our FAST response form. Fill out this form as completely as possible and we will promptly contact you to discuss your options.

For faster service call us direct! Call 555-555-5555.

The information you provide on this form will remain confidential

Tell us about you...

* Your First Name:

* Your Last Name:

* E-mail Address:

Day Time 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:

Property Zip:

The Property is currently:

No. of Bedrooms:

No. of Baths:

Square Footage:

Age of House:

Garage:

What is the general condition of the house:

Please describe any needed repairs in this box:

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
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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:

Are there other mortgages on the property:

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

If payments are not current, how far behind are they...

1st mortgage

$ Amount Behind:

# of payments:

2nd mortgage

$ Amount Behind:

# of payments:

Other mortgage

$ Amount Behind:

# of payments:

Have you received a foreclosure notice:

Has a foreclosure sale date been set:

Sale Date:

(Please click on the calendar icon to select the date)

Just a couple more questions...

Is your property currently listed with a real estate agent/broker

If property is listed when does your listing expire:

Are you currently in bankruptcy:

How did you hear about us:

Please provide any further comments that you feel are important in the box below:

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