Real Estate Lead Intake Form

Are you looking to sell your property?

Complete this form and we will contact you about your options.
Contact Information
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Mobile Number
Format: (000) 000-0000.
Second Number
Format: (000) 000-0000.
E-mail
Best Time to Call
Property Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Bedrooms:
Bathrooms:
What is the approximate square footage:
Year Built:
How many stories?
Garage:
What is the current condition of your property?
Is the house currently listed with a ®Realtor?
Is there anyone living in the house?
If No, has the house been previously listed?
If Yes, when does the listing expire?
Why are you selling?
Pricing Information
What do you think your house is worth?
How did you determine the value?
When would you like to sell
Are there any Liens on the property?
Are your property taxes current?
Is the title free and clear?
Do you pay Homeowner/Condo Association dues? If so, how much per year? $
How did you hear about us?
Do you have any questions or comments you would like to share with us?
Should be Empty:

Contact Information