New Seller - Client Intake Form

Thank you for your consideration in choosing me to help you sell your home! As your Elite realtor, you'll be offered top priority service, professionalism and elite guidance that will help direct you on making the best decision for your needs. By completing this form you will provide me insight on how I can best assist you in selling your home. Thank you again and I look forward to servicing you!
Contact Information
Contact's Full Name*

First NameLast Name
Contact's Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact's Phone Number*
Are you the:*

Agent/RealtorHome Owner
Existing Mortgage Information

(Required)
1st Mortgage $*
Lender Name
APR %
Monthly Pymt*
Is there a 2nd Mortgage?*

YesNo
2nd Mortgage $
Lender Name
APR %
Monthly Pymt*
Does payment include PITI? (Principal, Interest, Taxes & Insurance)*

YesNo
Are monthly payments current?*

YesNo
Amount behind (if any)?
If we can agree upon a price and we accept all responsibility for future repairs would you, or the owner, consider a lease purchase?*

YesNoUndecided
If the asking price and the loan balance are within $35,000 of each other would you, or the owner, sell the house for the amount you owe on it?*

YesNoUndecided
If the home is paid for in full, or almost paid for, would you, or the owner, consider taking monthly payments for your equity?*

YesNoUndecided
What is it that you need to have from the sale of your home?*

Need immediate payoff before losing the property.Take over payments because can't afford two house payments.No immediate concerns so I would be OK with accepting pre-determined payments for a specified length of time.Other
Please select the best day(s) of the week with when to contact you:*

MondayTuesdayWednesdayThursdayFridaySaturday
Please select the best time slot(s) which would be best to contact you:*

8:00am - 10:00am10:00am - 12:00pm12:00pm - 2:00pm2:00pm - 4:00pm4:00pm - 6:00pm
Asking Price*
Owner's Estimated Value*
How did you arrive at your asking price?*

Amount left on mortgageReal Estate Agent recommendedComparable home salesEqual to amount of equityOther
If Other, please explain:
Reason for selling?
Are any repairs needed?*

YesNo
If Yes, please explain:
If you currently reside in the residence, when would you want to move?
Is the property CURRENTLY listed with any realtor/agent?*

YesNo
If Yes, then how long has the property been listed?
Property Information
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Number of bedrooms:*
Number of bathrooms:*
Lot size:*
Type of construction:*
If Other, please explain:
Garage:*
Carport:

YesNo
Basement:*

YesNo
If Yes, is the basement finished or unfinished?
Select any appliances that will come with the home:*

RefrigeratorRangeMicrowaveDishwaherWasherDryer
Is the property:*

VacantOccupied
Is the property a condo?*

YesNo
Any Association fees?*

YesNo
If Yes, how much?
Please add any additional comments you feel are important about the property that were not covered above:
Should be Empty:

Contact Information

Existing Mortgage Information

Property Information