CONTACT INFORMATION

Please provide as much information as possible, so that we may serve you best:
(Fields in RED are required).

Name
E-mail
Day Phone
Evening Phone
Cell Phone

Do you have a property to sell?

Yes
No

TELL US ABOUT YOUR PENNSYLVANIA PROPERTY

What is the property address?

How much are you asking for the house?

$

Why are you selling?

Is the house listed with a real estate agent?

Yes
No

If your house is listed, who is the listing agent (name & phone)?

If you were to have the property appraised, what do you think it would be worth?

$

When do you want to settle?

As soon as possible
1-2 weeks
3-4 weeks
more than 4 weeks
Not sure

Does the house need any repairs?

None
A little bit
It needs a lot of work
It's a wreck

Please give a brief description of the repairs needed.

Are you in foreclosure?

Yes
No
Not yet, but soon

What is your loan balance?

$

What is your monthly payment?

$

Is there a second mortgage?

Yes
No

Yes
No
Not Sure

Are your payments current?

Yes
1-2 months behind
3-4 months behind
More than 4 months behind

Is the house vacant now?

Yes
No

What type of property do you have?

Single Family House
Townhouse/Rowhome
Duplex
Condominium
Land
Commercial
Other

How many bedrooms?

How many bathrooms?

What is the approximate square footage?

square feet

What type of construction?

Frame
Block
Brick
Stucco
Other

Where did you hear about Express Home Sales, LLC?

Newspaper Ad
Billboard
Search Engine
Radio
Allrealestate.com

Do you have any comments or questions for us?

Any information you submit will remain strictly confidential. We do not sell or share customer information.