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Name(s), including middle initial

Email Address

Phone Number

Business Phone

Cellular or Pager






Street address of subject property

Full legal description of property

Present owner of subject property

Is the owner an individual, an estate, a corporation or a partnership?

Is the property commercial or residential?

What is your intended use of the property?

Is the property mortgaged?

First mortgage balance

First mortgage company

Is the first mortgage current?

If not, amount behind?

Second and other subordinate mortgage balances, if any

Subordinate mortgage company

Are any second or other subordinate mortgages current?

If not, amount behind?

Are there any other liens on the property?

If so, please describe

Tax assessed value of property

Are there any taxes due on the property?

If so, please list

If applicable, to whom do you want to transfer the property?

Is there a title company working on this matter?

If so, please list contact information

Is there a real estate or other broker representing you on this matter?

If so, please list contact information

Are there any renters currently on the property?

Please describe any current legal proceedings (such as foreclosure, tax suits. lis pendens, eminent domain, etc.) involving the property.

What is your desired result (such as purchase, sell, mortgage, clear title, etc.)?

Special concerns or other relevant information

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