ATTENTION PHONE REPS: THIS FORM MUST BE ENTIRELY COMPLETED ON ALL INCOMING CALLS!! If the caller would like to know how we buy homes or how our program works, please complete the form and a representative will call them within 24-48 hours with an offer to buy their home and to discuss the details. For additional information, they can visit

Name :
Current Mailing Address :
City :
State :
Zip Code :
Phone :
Email - (type if you dont have an e-mail address) :
What is the address of the property you are selling?  :
What kind of house do you have for sale? :
Name of Development where home is located :
Why are you selling? :
What is the approximate 1st mortgage balance? :
Amount of 2nd Mortgage or Equity Mortgage - if any? :
What is/are the current mortgage payment(s)?  :
Is/Are the loan(s) behind in payments? :
If late, how many months? :
Does the house need repair?  :
What is the cost of the repairs? :
Please describe what repairs are needed  :
How many bedrooms and bathrooms? :
How long have you owned this house? :
Is the house vacant or occupied?  :
What are you asking for the house? :
What amount do you think it would appraise for?  :
How did you hear about us? :
Any additional information about the house or your situation :
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