Real Estate Agent Information Real Estate Agent's Name and Firm: __________________________________________________________________________ Real Estate Agent Cell Phone: _________________________ Office _________________
Owner Information Owner Name(s) Best Time to Contact: _______________ (We won’t contact your client until we have talked with you.) Home Phone: ______________________ Cell Phone: ____________________________ Work Phone: _______________________ Hardship: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Property Information Property Address: City: ______________________________ State: __________ Zip: ____________ Bed/Bath: ________________ Year Built: ___________SF:__________ Lot Size: __________ Vacant?_____________ Listed? _______ MLS # ___________________ How long? _________ Listing Price: ________________ Ugly [ ] Unconventional/Obsolete [ ] Victim [ ] Please Explain: _________________________________________________________________________ _________________________________________________________________________ Value of Home Current: ________________ Mint Condition: ____________ 30 Day Sale Price: ____________ Mortgage Information 1st Balance: _________________Lender: _____________________________ How far behind?______________ Loan Number: _______________________ PITI: ___________ Fixed [ ] Adjustable [ ] Foreclosure pending? ______________ 2nd Balance:_________________ Lender: _____________________________ How far behind? ______________ Loan Number: ______________________ PITI: ___________ Fixed [ ] Adjustable [ ] Foreclosure pending? ______________ 3rd Balance: _________________ Lender: _____________________________ How far behind? _____________ Loan Number: _______________________ PITI: ____________ Fixed [ ] Adjustable [ ] Foreclosure pending? _____________
Other Liens: _________________________________________________________________________ Anything Else We Should Know? __________________________________________________________________________ ___________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________
Please print out and complete this form, then fax to 252-257-5823. Remember… we will call you before we contact your client the first time. We want to work with you.