| I am interested in: |
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Special Listing Offer |
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Estimating my net proceeds |
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| Property Address |
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| City |
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| County |
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| zip |
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| State |
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| Name of Tract (if known) |
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| Name of model (if known) |
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| Number of bedrooms |
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| Number of bathrooms |
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| Approximate square footage |
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| Special rooms and features that
would add to value (please comment freely) |
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| Original price |
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| Year you purchased the home |
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| Balance on existing 1st mortgage |
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| Balance on existing 2nd mortgage |
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| Balances of any other liens |
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| Your estimate of value |
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| Your estimate is based on) |
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| Contact Information |
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| name |
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| email address |
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| daytime telephone |
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| night-time telephone |
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| street address |
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| city/state/zip |
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