Please complete this form to determine how the Payments can be taken over:

	Contact Info                                           Property Address
First Name*	Street
Last Name*	City
Work Phone	xxx-xxx-xxxx     State
Home Phone*	xxx-xxx-xxxx      Zip
E-mail*	County
	Property Info
Type of Home	Single Family HomeTown HouseCondoMulti FamilyOtherMobil Home   # Bedrooms 12345+    Baths 1234+  1/2 Bath 012
Sq. Ft.	500-10001000-15001500-20002000-25002500-30003500+     Home Age 1-3 Years3-5 Years5-7 Years7-10 Years10-15 Years15-20 Years20-25 Years25-30 YearsOlder House is Ok      Garage 123CarportNo GarageNo Carport
Home Condition	Needs WorkNeeds Lot of WorkVery GoodGoodFairExcellent              Pool YesNo     Water Front YesNo
Construction	BlockBrickFrameOther  Floors  12    # of Trees 0123        Tree Sizes SmallMediumBigLarge
Occupied	YesNo  If Not Occupied  VacantRented      If Rented (How much Rent)
	Financial Info
1st Loan Balance	Mo Payment  Payment Behind 012345678910111212+ Int Rate 4-55-66-77-88-99-1010-1111-1212-1313-1414-1515+
2nd Loan Balance	Mo Payment  Payment Behind 012345678910111212+ Int Rate 4-55-66-77-88-99-1010-1111-1212-1313-1414-1515+
3rd Loan Balance	Mo Payment  Payment Behind 012345678910111212+ Int Rate 4-55-66-77-88-99-1010-1111-1212-1313-1414-1515+
Liens on Property	Lien 1           Lien 2           Lien 3
House Value	If fix up needed how much?
	Deed and Mortgage Info
Names on Deed	Second Person    Third Person
Names on Mortgage	Second Person    Third Person
Selling Info	Appraised for     Sell it for
If I Buy it TODAY,	ALL CASH, AS-IS, What is the very LEAST you would sell it for?
When Can we	Meet?       ASAP Today Tomorrow Call me Now
	Please Note your information is100% CONFIDENTIAL