Short Sale Request Form

Please fill in all applicable fields. This form is confidential.

Contact Information
First Name*
Last Name*
Email Address*
Phone Number*
Mailing Address *
City *
State*
Zip*
Property Information
Subject Property Address *
City *
State*
Zip*
Property Ownership *	Primary Residence Investment Second Home
Property Occupancy *	Occupied Vacant
Loan Information
1st Lender Name *
Is your 1st loan one of the following?*	FHA VA
What is the approximate loan balance?*
2nd Lender Name (if applicable)
What is the approximate loan balance?
3rd Lender Name (if applicable)
What is the approximate loan balance?
Are any of the loans listed above Equity Lines of Credit? If yes, please indicate which ones.
Are all of the loans listed above the original loans you applied for when you purchased the home?*	Yes No
If no, which loans were refinanced? Also, please indicate if you took cash out when you refinanced.
Additional Questions
Are their any other liens on the property? If yes, please indicate what type. (IRS, etc.)
Do you have Mortgage Insurance?	Yes No
What date did you make your last mortgage payment?*
Do you have a foreclose sale date? If yes, what is the date?*
Have you recently spoke with your bank about your options?*
Have you spoken to another agent or real estate team in regards to a short sale?*
What is most important to you in this transaction?*
Additional comments?
How did you hear about us?*	Family Friend Facebook Twitter Craigslist Other Website Other

Thank you! We will be in touch soon!

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