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Please fill out as completely as possible. All information is confidential.
Name :
Email :
Home Phone :
Work/Cell Phone :
Property Address :
City :
State :
Zip :
Approximate square footage? :
Property type? :
How many bedrooms and bathrooms? :
Are there any loans outstanding? :
What are the balances? :
Are the loans current? :
If late, how many months? :
What is the current mortgage payment(s)?  :
Does the house need repair?  :
Please describe what repairs are needed  :
Year Acquired :
Is the house vacant or occupied?  :
How soon do you want to sell? :
Est. Value of home :
Source of Value :
Listed w/Realtor :
Why are you selling? :
If I could offer you cash and close quickly, what would be the least you would take?  :
How did you hear about us? :
Additional notes :
 
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