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First Name
*
Last Name
*
Email Address
*
Home Phone
Mobile Phone
Work Phone
Property Address
*
City
*
State
*
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DC
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South Carolina
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Zip
*
Approx. Square Feet
*
Bedrooms
*
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1
2
3
4
5 +
Bathrooms
*
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1
1.5
2
2.5
3
3.5
4 +
Garage
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None
1
2
3
4 +
Pool
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No
Yes
Is it Occupied?
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No
Yes
Property Type
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Single Family
Townhome
Condo
Multi Tennant
Mobile Home
Listed with a Realtor?
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No
Yes
If Yes, List Price?
Estimated Home Value
Source of Value
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Appraisal
Realtor CMA
Tax Value
Guess
Other
Asking Price
List Any Repairs
Why are you selling?
1st Mortgage
Balance
Interest %
Payment
2nd Mortgage
Balance
Interest %
Payment
Are you Behind?
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No
Yes
In Foreclosure
If Behind - By how much?
How did you find us?
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Google
Yahoo!
Other Search Engine
Radio
TV
Print Ad
Word of Mouth
Billboard
Road Sign
Other
Enter any additional notes or comments
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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