Terillian Real Estate


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	Instructions Remove N/A in fields where you need to input information. All fields must be filled in prior to submission, fill empty fields with N/A.

	First Name Last Name Day Phone Evening Phone Best time to call Email ------------------------------------------------ Explain your situation: How soon do you need to sell: ------------------------------------------------ Property Information Address Explain what kind of repairs are needed: Is the house listed with a Realtor? ------------------------------------------------ Price & Terms (fill in the N/A fields if necessary) What is your asking price? How did you determine that price? First Mortgage (principal balance) Interest Rate Second Mortgage (principal balance) Interest Rate Third Mortgage (principal balance) Interest Rate Home Equity Line of Credit (principal balance) Would you sell your house for what you owe on it? Would you be willing to receive monthly payments for equity? Would you be willing to let us take over the payments? If you could sell your house in 7 days or less, how much would you be willing to accept for the quick sale? Questions?: