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First Name		Last Name
Home Phone		Cell Phone
Work Phone		Email Address
Address
City		State	Zip
County
Subdivision Name (if any)
# of Bedrooms # 1 2 3 4 5 6 7 8+	# of Bathrooms # 1 1.5 2 2.5 3 3.5 4 5+
Approximate Sq. Footage --Select -- < 1000 1001-1250 1251-1500 1501-1750 1751-2000 2001-2250 2251-2500 2501-2750 2751-3000 3001+
Basement --Select-- Finished Unfinished None	Carport --Select-- Yes No	Garage --Select-- Yes No
Lot Size --Select-- < 1/2 Acre 1/2 - 3/4 Acre 3/4 - 1 Acre 1 Acre+	Stories --Select-- 1 2 Split	Age of Home --Select-- New 3-5 years 5-10 years 10-15 years 15-20 years 20-30 years 30+ years
Is home occupied? --Select-- Yes No	Is home listed with realtor? --Select-- Yes No
Monthly Mortgage Payment
Estimated Home Value		Estimated Repairs Needed
1st Mortgage Payoff Amount		2nd Mortgage Payoff Amount
Current on Payments? --Select-- Yes No		Amount Owed for Backpayments
Reason for Selling
How Quickly Do You Need to Sell? --Select-- ASAP 2 Weeks 4 Weeks 1-2 Months 2 Months+ No Hurry
If I pay you all cash and close quickly what is the least amount you would accept?
How did you hear about us? --Select-- Search Engine Radio TV Print Ad Word of Mouth Billboard Road Sign Other