Tell Us About Your Property

**All information you provide will be kept in strict confidentiality and will be used solely for the purpose of qualifications **

Tell Us About Your Property
How did you hear about us?*	select News Journal Road sign Internet, Radio Newspaper ad Referral Other
Name*
Address*
City*
State*	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code*
Phone*
Alternate Phone
Fax
Email*
Property Address*
City*
State*	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip*
How long have you lived at this address?
What type of property is it?
How many bedrooms do you have?
How many baths?
Type of Parking	Select One driveway garage driveway/garage on-street parking
Development name (if applicable)
Is house vacant?	Yes No
If YES - How long?
If NO - When do you plan to move?
Is the house listed w/a realtor?
If yes, what is the listing price?
If, no how much do you think the house is worth?
How did you arrive at that figure?
If I where to have the home appraised in the next few days, what do you think it would appraise for?
What is the approximate balance of your mortgage?
Is there a second mortgage or line of credit/home equity loan?
Approximate balance of the second?
Are the loans current?
If not, how many months are you behind?
How would you rate the homes condition?
If repairs are needed, please briefly describe: List the repairs need and estimated cost of the repairs, if known
Do you think you can raise enough cash to cure the defaults? (if you are already behind)
Do you think you can qualify for a new mortgage?	Yes No
If you did qualify for a new loan, can you handle a bigger monthly payment?	Yes No
Would you consider selling the home?
Have you filed bankruptcy?	Yes No
Any additional information, comments, or background on your situation.
Verification	Enter the letters you see in the image above. This ensures that a real person, not an automated program, is entering this information.
* Required Field
Please click only once.