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Instant Cash Offer Form
Owner Information
First Name*:
Last Name*:
Address of Property For Sale:
City:
State:
Zip Code:
Email address*:
Daytime Phone*:
Evening Phone:
Mobile Phone:
Are you the owner?
Yes
No
If "No", Please list the owner's name:
How quickly do you need to sell?*:
Choose Option
As Soon As Possible
1 to 2 months
3 to 6 months
7 to 12 months
More than a year
Reason for Sale*:
Property Information
Propery Type:
Property or Home Condition:
Estimated Value:
Choose Option
$0 - $25,000
$26,000 - $50,000
$51,000 - $75,000
$76,000 - $100,000
$101,000 - $150,000
$151,000 - $175,000
$176,000 - $200,000
$201,000 - $250,000
$251,000 - $300,000
$301,000 - $400,000
$401,000 - $500,000
$501,000 - $600,000
$601,000 - $700,000
$701,000 - $800,000
$801,000 - $900,000
$1,000,000 +
How much would you sell for if you could get a fast sale now?*:
Square Footage (if known):
Choose Option
1500 sq. ft. or less
1500 - 2000 sq. ft.
2000 - 3000 sq. ft.
3000 - 4000 sq. ft.
4000 - 5000 sq. ft.
5000 sq. ft. or more
Number of Bedrooms:
Choose Option
One
Two
Three
Four
Five
More than Five
Number of Bathrooms:
Choose Option
One Half
One Full
One Full, One Half
Two Full
Two Full, One Half
Three Full
Three Full, One Half
More than Three
Stories:
Choose Option
One
Two
Three
More than Three
Age of Home:
Choose Option
1 - 5 years
6 - 10 years
11 - 20 years
21 - 30 years
31 - 40 years
41 - 50 years
51 - 60 years
61 - 70 years
71 - 80 years
81 - 90 years
91 - 100 years
100 or more
Pool?:
Yes
No
Garage?:
Yes
No
Is the property occupied?:
Yes
No
Is the property listed with a realtor?:
Yes
No
Mortgage Information
1st Mortgage balance estimate:
Monthly Payment:
Are your payments current?:
Yes
No
If you are behind on payments, how many are you behind?:
Choose Option
1 - 2
3 - 4
4 - 5
5 or more
Do you have a 2nd mortgage or home equity loan?:
Yes
No
Are you current on payments?
Yes
No
2nd mortgage or equity loan balance estimate:
Do you have any additional questions or comments?
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