Selling
Name
Phone Number
Email
What type of home is it?
Single Family
Condo
Townhouse
Multiple Family
Mobile or Manufactured Home
What is the street address of the home?
What is the city, state and zip?
,
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
How many bedrooms?
1
2
3
4
5
6
7
8 or more
How many bathrooms?
1
1.5
2
2.5
3
3.5
4
4.5
5 or more
Approximate square footage:
500
750
1000
1250
1500
1750
2000
2250
2500
2750
3000
3250
3500
3750
4000
4250
4500
4750
5000
over 5000
sqft
Approximate lot size:
Condo or City Lot
1/4 Acre
1/2 Acre
1 Acre
2-5 Acres
5-10 Acres
10+ Acres
Unsure
What do you think the home is worth?
$100,000 or Less
$100,001 - $105,000
$105,001 - $110,000
$110,001 - $115,000
$115,001 - $120,000
$120,001 - $125,000
$125,001 - $130,000
$130,001 - $135,000
$135,001 - $140,000
$140,001 - $145,000
$145,001 - $150,000
$150,001 - $155,000
$155,001 - $160,000
$160,001 - $165,000
$165,001 - $170,000
$170,001 - $175,000
$175,001 - $180,000
$180,001 - $185,000
$185,001 - $190,000
$190,001 - $195,000
$195,001 - $200,000
$200,001 - $210,000
$210,001 - $220,000
$220,001 - $230,000
$230,001 - $240,000
$240,001 - $250,000
$250,001 - $260,000
$260,001 - $270,000
$270,001 - $280,000
$280,001 - $290,000
$290,001 - $300,000
$300,001 - $310,000
$310,001 - $320,000
$320,001 - $330,000
$330,001 - $340,000
$340,001 - $350,000
$350,001 - $360,000
$360,001 - $370,000
$370,001 - $380,000
$380,001 - $390,000
$390,001 - $400,000
$400,001 - $420,000
$420,001 - $440,000
$440,001 - $460,000
$460,001 - $480,000
$480,001 - $500,000
$500,001 - $520,000
$520,001 - $540,000
$540,001 - $560,000
$560,001 - $580,000
$580,001 - $600,000
$600,001 - $620,000
$620,001 - $640,000
$640,001 - $660,000
$660,001 - $680,000
$680,001 - $700,000
$700,001 - $720,000
$720,001 - $740,000
$740,001 - $760,000
$760,001 - $780,000
$780,001 - $800,000
$800,001 - $820,000
$820,001 - $840,000
$840,001 - $860,000
$860,001 - $880,000
$880,001 - $900,000
$900,001 - $920,000
$920,001 - $940,000
$940,001 - $960,000
$960,001 - $980,000
$980,001 - $1,000,000
$1,000,000+
$1,500,000+
$2,000,000+
$2,500,000+
How soon do you hope to sell the home?
Not Selling
Less than 1 Month
1 - 2 Months
2 - 3 Months
3 - 6 Months
More than 6 Months
Are you behind in your mortgage payments?
No
Yes, 1 payment
Yes, 2 payments
Yes, 3 or more payments
Why do you want to know what your home is worth?
Refinancing to a lower rate
Need a home equity loan
Selling a home
Buying a home
Need homeowners insurance
Property tax appraisal is too high
Just curious
Other
Would you like FREE refinancing offers?
Yes
No
Square Feet
500
750
1000
1250
1500
1750
2000
2250
2500
2750
3000
3250
3500
3750
4000
4250
4500
4750
5000
over 5000
to
500
750
1000
1250
1500
1750
2000
2250
2500
2750
3000
3250
3500
3750
4000
4250
4500
4750
5000
over 5000
# of Bedrooms
# of Bathrooms
Price
Less than $50,000
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
More than $850,000
to
Less than $50,000
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$850,000
More than $850,000
Garage
Mortgage Principle
Total Payments
Monthly Payments
