Please take a few minutes to fill out this form to help us get an idea about your situation.

All information is confidential. We will not resell or release the information to anyone else, your information will only be used by The House Business.

Name (required):

Phone Number (required):

Email (required):

Street Address (required):

City (required):

Zip Code (required):

Number of Bedrooms

Number of Baths

Square Footage

Lot Size

Mortgage Information

What is your 1st mortgage balance?

Monthly payment: $

Mortgage holder:

What is your 2nd mortgage balance?

Monthly payment: $

Mortgage holder:

Is there an equity line of credit on your home?
   If "yes" please provide more information
Balance:
Payment:
Holder:

Total you owe on the home:

Total monthly payments:

How much is your home worth?

Are your payments current?

If "no" please tell us how many payments you are behind and the amount you are behind

1st mortgage
Number of payments behind:

Amount: $

2nd mortgage
Number of payments behind:

Amount: $

Equity Line
Number of payments behind:

Amount: $

Please tell us about any Foreclosure Warning Letters or Notice of Foreclosure Letters your have received. Tell us when you received them and if a Foreclosure sale date has been set.

Is the home in need of any repairs?

If "yes" please describe.