First Name

Last Name

Address

Town/City

State

Zip Code

Telephone #

E-mail Address

Name of Owner/Owners Of Record with county ?

Property Address ?

Property City ?

Property State ?

Property Zip ?

Parcel Number (APN) ?

Size of Property (In Sqft  and  Acres) ?

How Many bedrooms?

How Many Baths?

Has the property ever had water damage ?

How long have you owned the property ?

How did you acquire the property ?

Do you own the property free and clear( If No Please Explain)  mortgages etc. ?  

Mortgage Amount?

Monthly  Payment ?

Do you Know the worth of the property ?

Occupancy ?

How did you arrive at this value ?

Are their any repairs needed, If so what kind ?

Any other comments ?