Contact Information

First name: Last name:

Home phone/Area code: Number:

Cell phone/Area code: Number:

Email address:

Mailing/Street address: Unit #:  

City: State: Zip code:

Property Information

What is the purpose of the Short Sale? 

Rate increase  Behind in payments  Loss of job  Death in family

  Illness in family     Disability    Loss of income - Other:

Property previously on the market? Yes No  

How long:   Price:   

What type of property do you have?

Condo     Townhouse     Single Family     Land     Commercial

 #/Bedrooms:      #/bathrooms:     Sqft:     

Pool     Spa    Other:  

 Zoning/Land & Commercial only:  

Property/address: Same as above     (If different fill out address below.)

Property/Street address:  

Unit #:  

City: State: Zip code:

Loan and debt information

How much do you owe? 

1st loan: 2nd loan: 3rd loan:  

Do you owe back taxes? If so, how much?   

Any other loans/debts?  Loan default? Yes No  

Have you filed bankruptcy? Yes No  -  If so, when:  

Can you tell us more?

Any idea of how much your property is worth?      

If so, how did you determine the value? Neighbor's House     Appraisal    

  Refinance     Realtor     Other:

When are you ready to start the Short Sale process? (keep in mind it could take up to 90 days)

Now        30 days        90 days        6 months        1 year

What questions do you have?

Brief survey

How did you hear about us? Internet TV/cable Newspaper  Homes

& Land Magazine Yard sign  Bus bench    US mail  Email message 

Past client        Other: