HomeHeadacheRelief.com

Please complete all the *REQUIRED fileds with accurate information.

Contact Information

Owner First Name:*

Owner Last Name:*

Owner Email Address:*

Co-Signer First Name:

Co-Signer Last Name:

Day Phone:*
( )

Evening Phone:*
( )

Mobile Phone/Pager:
( )

Best Time to Call:

Situation

Do you need to sell your house fast?* Yes No

Explain your situation and/or why you need to sell your property:*

How soon do you need to move?

Property Location

Property Address:*
City:*	State:*	Zip:*

Property County:*

Property Description

Home Style:
Stories/Floors:*	Bedrooms:*	Bathrooms:*

Year Built:

Square Footage:*		Lot Size/Acreage:
Garage:*		Basement:*

Construction:

Property Information

How long have you owned this house?*	What is the current condition of your property?*

What kind of repairs and maintenance does the house need?*

How much do you think these repairs will cost?* $	Is there anyone living in the house?*

How long has the property been for sale?*
Is the property currently listed with a real estate agent?* Yes No
When does the listing expire?* Has the property been previously listed?* Yes No

Property Value

How much are you asking us to pay for your house?* $	How did you determine your asking price?*
If we were to have your house appraised, how much do you think it would be worth?* $

Mortgages and Liens

How many mortgages are held against this property?*

Mortgage 1

Financial Institution:*

Balance:*
$

Monthly Payment:*
$

Interest Rate:*
% Fixed ARM

Are The Payments Current?* Yes No

How far behind?* $

Mortgage 2

Financial Institution:

Balance:
$

Monthly Payment:
$

Interest Rate:
% Fixed ARM

Are The Payments Current? Yes No

How far behind? $

Mortgage 3

Financial Institution:

Balance:
$

Monthly Payment:
$

Interest Rate:
% Fixed ARM

Are The Payments Current? Yes No

How far behind? $

Mortgage 4

Financial Institution:

Balance:
$

Monthly Payment:
$

Interest Rate:
% Fixed ARM

Are The Payments Current? Yes No

How far behind? $

How much are your total annual property taxes?*
$

Are your property taxes and insurance included
in your monthly payment?* Yes No

Do you pay Homeowner/Condo Association dues?* Yes No

How much are your Homeowner/Condo Association dues per year? $

Seller Survey

Would you sell your house for what you owe on it?*
Yes No Undecided

Would you be willing to receive any of your equity, if applicable, in the form of monthly payments?*
Yes No Undecided

Would you be willing to sell your house by allowing us to take over your monthly mortgage payments?*
Yes No Undecided

If we were able to buy your house in 7 Days or less,
what is the least you could accept?*
$

How did you hear about us?

Do you have any questions or comments you would like to share with us?