First Name*
Last Name*
Email Address*
Home Phone*
Mobile Phone*
Work Phone
Property Street Address*
City*
State*
-- Select --
Indiana
Kentucky
Zip*
Your Mailing Address, if
different from Property Address*
Square Feet
Main*
Bedrooms
*
--
Select --
1
2
3
4
5 +
Bathrooms*
--
Select --
1
1.5
2
2.5
3
3.5
4 +
Master Bedroom on :*
--
Select --
1st Floor
2nd Floor
Other
Age of House?*
Occupied* ?
--
Select --
No
Yes - by owner
Yes - by tenant / other
Basement?*
--
Select --
Yes
No
Basement Sq Ft*
Basement Sq Ft
Finished*
Air Conditioning*
--
Select --
Central Air
No Central Air
Window Units
Heat System*
--
Select --
Central Forced Air - Gas
Central Forced Air - Propane
Central Forced Air - Heat Pump
Baseboard Water Heat with Boiler
Fuel Oil Heat
Other
Sewers*
--
Select --
City Sewers
Septic
Other
Parking*
--
Select --
Driveway only
1 car attached garage
2 car attached garage
2 + car attached garage
1 car detached garage
2 car detached garage
2+ car detached garage
Carport
Homeowners Assoc fees * Fireplace?*
--
Select --
Yes - fireplace
No - fireplace
Property Type*
--
Select --
Single Family
Townhome
Condo
Multi Tennant
Mobile Home
Listed w/Realtor?*
--
Select --
No
Yes
Listing Price
List
Appliances Included*
On a scale of 1 - 10,
what is overall condition of your house (1 being
poor and 10 being pristine)*
--Select--
1 - Very poor condition
2
3
4
5
6
7
8
9
10 - Pristine - house is in excellent resale condition
What is condition of carpet,
scaled 1-10*
--Select--
1 - Needs to be replaced
2
3
4
5
6
7
8
9
10- Carpet is like new
What is condition of paint,
scaled 1-10*
--Select--
1 - Needs painting
2
3
4
5
6
7
8
9
10- Paint is like new
What is condition of Roof, scaled
1-10?*
--Select--
1
2
3
4
5
6
7
8
9
10
List Any Recent Repairs or
Improvements (Roof, HVAC, Cabinets, flooring,
painting, remodeling, etc)*
List
Any Repairs Needed*
When do you need to sell?*
Select One
Right away
1 - 3 Months
3 - 6 months
6 - 9 months
No big hurry
Why are
you selling? Be explicit please
- this will help us structure an offer
that fits your needs*
Would you sell your house for
what you owe on it?*
Select One
Yes
No
Not sure
Would you allow us to take over
your monthly payment?*
Select One
Yes
No
Maybe - need more info
Fixed or Adjustable*
Select One
Fixed
Adjustable
Type Loan
Select One
FHA
VA
Conv
Other
Not Sure
Lender 1st Mortgage
Fixed or Adjustable*
Select One
Fixed
Adjustable
Type Loan
Select One
FHA
VA
Conv
Other
Not Sure
Lender 2nd Mortgage or HELOC
Are you Behind?*
--
Select --
No
Yes
In Foreclosure
Amount Behind $*
How did you find us?*
--
Select --
Mail Piece
Flyer
Print Ad
Word of Mouth
RentalHouses.com
Road Sign
Billboard
Other
Are
your property taxes and insurance included in
your 1st mortgage payment?*
Select One
Yes
No
Not sure
On a scale of 1 - 10, how badly
do you need to Sell?*
--Select--
1 - Little urgency to sell
2
3
4
5
6
7
8
9
10 - I REALLY need to sell!
Notes - List any
other liens or judgments against the house*
Referred by:
