Fast Response Form

FAST RESPONSE Form

Please fill in any information you feel comfortable sharing with me. Only answer the questions you want to and leave the rest.

I will contact you promptly and we can discuss your options.

The information you provide on this form will remain absolutely confidential

My Promise

If you are selling your house because you are having money troubles or you are embarrassed in any way you can count on me to treat you with dignity and respect. I will not criticize you or judge you. I will make selling your house as pleasant as possible under the circumstances.

John Ellerm

Tell us about you...

* Your First Name:

* Your Last Name:

E-mail Address:

Day Time Phone:
(Please include area code)

Evening Phone:
(Please include area code)

Best Time To Call:

Tell us about the property...

Property street address:

Property city:

Property state:

Property Zip:

The Property is currently:

No. of Bedrooms:

No. of Baths:

Square Footage:

Age of House:

Garage:

What is the general condition of the house:

Please describe any needed repairs in this box:

Check all that apply

Wood Floors	Formal Dining Room
Carpeting	Game Room
Tile	Fireplace
Finished Basement	Deck

Unfinished Basement	Swimming Pool
Privacy Fence	Other Fence
Brick	Vinyl Siding
Steel Siding	Wood Siding

Other Siding	Stucco
Central Heat	Central Air
Floor Furnace	Wood Stove
Septic Tank	Crawl Space

Slab	Storage Shed
Shop

Tell us about the numbers...

How much do you feel the property is worth:

1st mortgage balance:

1st mortgage payment amount:

Does the 1st mortgage payment include taxes and insurance:

Are there other mortgages on the property:

What is the combined balance of all mortgages:

What is the combined monthly payment on all mortgages:

Please tell us about any other liens and/or other title problems that may affect this property by typing an explanation here:

Are all mortgage payments current:
If payments are current click here

If payments are not current, how far behind are they...

1st mortgage

$ Amount Behind:

# of payments:

2nd mortgage

$ Amount Behind:

# of payments:

Other mortgage

$ Amount Behind:

# of payments:

Have you received a foreclosure notice:

Has a foreclosure sale date been set:

Sale Date:

(Please click on the calendar icon to select the date)

Just a couple more questions...

Is your property currently listed with a real estate agent/broker

If property is listed when does your listing expire:

Are you currently in bankruptcy:

How did you hear about us:

Please provide any further comments that you feel are important in the box below: