Fast Response Form

Following is our FAST response form. Fill out this form as completely as possible and we will promptly contact you to discuss your options.

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877-277-6817 ext 3

The information you provide on this form will remain confidential.

Tell us about you...
* Your First Name: * Your Last Name: E-mail Address: Day Time Phone:
(Please include area code) Evening Phone:
(Please include area code) Best Time To Call: Please tell us about the property.
Property street address: Property city: Property state: Please selectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Property Zip: The Property is currently: Please selectOwner OccupiedOccupied by RenterVacant No. of Bedrooms: <1123455+ No. of Baths: <1123455+ Square Footage: Age of House: Garage: Please selectOne Car AttachedOne Car DetachedTwo Car AttachedTwo Car DetachedCarportNoneOther What is the general condition of the house: Please selectExcellentGoodFairPoorUGLY! Please describe any needed repairs in this box: Check all that apply

Wood Floors	Formal Dining Room
Carpeting	Game Room
Tile	Fireplace
Finished Basement	Deck
Unfinished Basement	Swimming Pool
Privacy Fence	Other Fence
Brick	Vinyl Siding
Steel Siding	Wood Siding
Other Siding	Stucco
Central Heat	Central Air
Floor Furnace	Wood Stove
Septic Tank	Crawl Space
Slab	Storage Shed
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Tell us about the numbers...
How much do you feel the property is worth: 1st mortgage balance: 1st mortgage payment amount: Does the 1st mortgage payment include taxes and insurance: YesNo Are there other mortgages on the property: YesNo What is the combined balance of all mortgages: What is the combined monthly payment on all mortgages: Please tell us about any other liens and/or other title problems that may affect this property by typing an explanation here: Are all mortgage payments current:
If payments are current click here YesNo If payments are not current, how far behind are they...
1st mortgage
$ Amount Behind: # of payments: 2nd mortgage
$ Amount Behind: # of payments: Other mortgage
$ Amount Behind: # of payments: Have you received a foreclosure notice: YesNo Has a foreclosure sale date been set: YesNoUnknown Sale Date:  (Please click on the calendar icon to select the date) Just a couple more questions...
Is your property currently listed with a real estate agent/broker YesNo If property is listed when does your listing expire: Are you currently in bankruptcy: YesNo How did you hear about us: Please selectReferral from AttorneyReferral from CPAReferral from FriendReferral from RealtorLocal NewspaperPostcardLetterInternet search engineLink from other Internet siteOther Please provide any further comments that you feel are important in the box below:
   
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