SELLER’S INTAKE FORM
FROM GOALS TO SOLD
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Are you Married?
*
Please Select
Yes
No
If Married, is there joint ownership?
*
Please Select
Yes
No
Spouse Name
First Name
Last Name
Spouse Email
example@example.com
Spouse Address (If Different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Tell Me About Your Home
Do you live in the home?
*
Renters?
*
Please Select
Yes
No
If vacant, how long?
If vacant, are the utilities still connected?
Have you been on the market before?
*
Please Select
Yes
No
If so when?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Approximation
Reason for selling?
Specify Style of Home
Single occupancy house
Apartment/Loft
Flat
Ranch Style
Bungalow
Split Level
Duplex
Other
What is the age of your home?
How would you rate the condition of your home? (Ex. Excellent, Good, Fair, Needs Work)
Number of Bedrooms
*
Number of Bathrooms
*
Fireplace?
*
Please Select
Yes
No
Garage?
*
Please Select
Yes
No
Garage Type
*
Please Select
Attached
Detached
Spaces (Cars)?
*
Please Select
2
3+
Basement
Full
Partial
Walkout
Finished
Unfinished
Crawl
Slab
N/A
Notes/Updates/Issues - Anything that impacts salability:
Has your home ever flooded?
Yes
No
Does your home require flood insurance?
Yes
No
If yes, what is your annual premium?
Signature
Submit
Should be Empty: