Your full name:

Your email address:

Your phone number:

Why Do You Need to Eliminate Your Mortgage?: —Please choose an option—To Prevent ForeclosureMoved Into New HouseJob Loss/DownsizedJob RelocationDivorceInherited PropertyFrustrating TenantsOthers

How quickly do you need to get rid of your mortgage?: —Please choose an option—Yesterday!Within Next 30 DaysWithin Next Few WeeksSometime Next MonthNo Rush

DESIRED Move-Out Date?:

Property Address:

Zip Code:

Neighborhood:

Are you the Owner of the Property?: —Please choose an option—YesNo

Years Owned?:

Property Type: —Please choose an option—Single FamilyDuplex3 Units4 Units4+ Units

# of Bedrooms: —Please choose an option—123456

# of Bathrooms: —Please choose an option—11.522.533.54+

Approx. Square Footage: —Please choose an option—750 - 10001001 - 12501251 - 15001501 - 17501751 - 20002001 - 25002500+

Is the Property Vacant?: —Please choose an option—YesNo

Best guess on amount owed (total owed):

Amount of monthly payment?:

Any amount in arrears?:

Do you have a fixed-rate mortgage or an adjustment rate mortgage?: —Please choose an option—Adjustable (ARM)Fixed

Comments (write 'n/a' if none):