First Name
*
Last Name
*
Email Address
*
Home Phone
Mobile Phone
Work Phone
Property Street Address
*
City
*
State
*
Zip
*
--Select--
WY
CO
Approximate Sq Footage
Bedrooms
*
Bathrooms
*
Garage
--Select--
1
2
3
4
5+
--Select--
1
1.5
2
2.5
3
3.5
4+
--Select--
1
2
3
4+
Pool?
Occupied?
Property Type?
Yes
No
Yes
No
--Select--
Single Family
Condo
Multi-Tenant
Mobile Home
Listed with Realtor?
Yes
No
Listing Price
Estimated Home Value
Source of Value
--Select--
Appraisal
Realtor CMA
Tax Value
Guess
Other
Asking Price
Asking Price - Cash
Comments
How did you find us?
--Select--
Google
Yahoo!
Other Search Engine
Radio Ad
Print Ad
Word of Mouth
Billboard
Road Sign
Other
List any repairs
Why are you selling?
Are you behind?
Yes
No
Foreclosure
Amount behind(If applicable)
1st Mort. Balance
2nd Mort. Balance
1st Mort. Interest
2nd Mort. Interest
1st Mort. Payment
2nd Mort. Payment
Untitled Document
*Jim Ward is associated with
Equality Real Estate Inc
. ©2010
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