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Real Estate Agent Information
Real Estate Agent
Name :
Real Estate Agent
Brokerage :
Real Estate Agent
Cell Phone :
Real Estate Agent
Email Address :
Owner Information
Owner 1 Name :
Owner 2 Name :
Home Phone :
Cell Phone Owner
1:
Cell Phone Owner
2:
Email Owner 1 :
Email Owner 2
:
Mailing Address if
Different than Property Address :
Describe Seller's
Hardship :
Property Information
Property Address :
Property City :
Property State :
Select State
Kentucky
Florida
Georgia
Indiana
Property Zip :
Property County :
Bedrooms :
0
1
2
3
4
5
6+
Full Bathrooms :
0
1
2
3
4
5
6+
Half Bathrooms :
0
1
2
3
4
5
6+
Garage? :
Select
1 Car
2 Car
3 Car
Select
Attached
Detached
Basement? :
Select
Yes
No
Select Yes or No
Pool? :
Select
Yes
No
Select Yes or No
Year Built :
Square Footage :
Lot Size (Acres) :
List any Other Significant Features:
Occupied? :
Select
Yes
No
If Yes, by Whom
Listed with Realtor? :
Select
Yes
No
Select Yes or No
If yes, how long
has it been listed? :
Listing Price :
Property Situation
(check all that apply) :
List any Repairs Needed :
Is this the Seller's Primary
Residence? :
Select
Yes
No
Select Yes or No
Can the house be
sold for enough to pay off what you owe? :
Select
Yes
No
Select Yes or No
Do you have the means
to solve the situation on your
own? :
Select
Yes
No
Select Yes or No
Do you
want to stay in the house? :
Select
Yes
No
Select Yes or No
Are you willing to move and walk away from the
house? :
Select
Yes
No
Select Yes or No
Is the
foreclosure sale date scheduled? :
Select
Yes
No
If Yes,
When
Is there a divorce
involved ? :
Select
Yes
No
If Yes, Status
Has Seller
Attempted a Loan Modification? :
Select
Yes
No
Select Yes or No
Value of Home
Current Value :
Value in Mint
Condition :
30 - 60 Day Sale
Price :
If known
Mortgage Information
Has
the Lender Been Approached About Doing a Short Sale?:
Select
Yes
No
Select Yes or No
Has an
Offer Been Presented to Lender?:
Select
Yes
No
Select Yes or No
If Yes, How Long
Ago? :
How Much was the
Offer? :
What is the Status
of Offer? :
Has the lender
done a BPO? :
Select
Yes
No
Select Yes or No
If Yes, How Long
Ago? :
:
1st Mortgage
Balance :
1st Mortgage
Lender :
1st Loan Number :
How Far Behind? :
2nd Mortgage
Balance :
2nd Mortgage
Lender :
2nd Mortgage
Loan Number :
How Far Behind? :
:
3rd Mortgage
Balance :
3rd Mortgage
Lender :
3rd Mortgage
Loan Number :
How Far Behind? :
:
Other Liens :
Anything Else We
Should Know?
(ie Describe any Bankruptcy,
actual or contemplated, etc)
If Seller is Not Located
in the same County as the Property, list the State
and County for EACH Seller for Notary Purposes
If you are unable to answer a required
question, give us your best guess or enter a "?" or
"NA".
To insure you
are a real person, please enter "submitnow" in the
following box and then hit the submit button:
