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!
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  
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:  
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:  
Captcha Code:
* Enter Code Above:
   

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