Name(s), including middle initial

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Email Address

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Phone Number

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Business Phone

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Cellular or Pager

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Address

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County

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City

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State

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Zip

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Street address of subject property

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Full legal description of property

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Present owner of subject property

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

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Is the property commercial or residential?

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What is your intended use of the property?

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Is the property mortgaged?
yes   no
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First mortgage balance

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First mortgage company

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Is the first mortgage current?
yes   no
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If not, amount behind?

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Second and other subordinate mortgage balances, if any

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Subordinate mortgage company

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Are any second or other subordinate mortgages current?
yes   no
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If not, amount behind?

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Are there any other liens on the property?

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If so, please describe

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Tax assessed value of property

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Are there any taxes due on the property?
yes   no
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If so, please list

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

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Is there a title company working on this matter?
yes   no
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If so, please list contact information

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Is there a real estate or other broker representing you on this matter?
yes   no
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If so, please list contact information

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Are there any renters currently on the property?
yes   no
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Please describe any current legal proceedings (such as foreclosure, tax suits. lis pendens, eminent domain, etc.) involving the property.

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

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Special concerns or other relevant information

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