Approximate Home Value:                               $

Approximate Pending Foreclosure:                  $

Additional Liens(Taxes, Etc.):                          $

Mortgage Company / Loan Type (farm, etc.):    

Last Mortgage Statement:                                YES NO

Recent Appraisal :                                             YES NO

Copy of Appraisal :                                           YES NO

Mr. / Mrs. / Ms.:    

Premise Address: 
                                                                          

Telephone:           Cell:                      

SSN# Borrower 1: SSN# Borrower 2:

Driver License 1:   Driver License 2:  

County: Tax Block:    Tax Lot:

If copy of deed available: Book #            Page # 

Style of Home:       Historic House: YES NO    Year Built:

# of Bedrooms:                 # of Bathrooms:  

Square Feet of Home:   Property Size:   

Basement: YES NO     Finished: YES NO       Natural Gas: YES NO

Well Water Town Water          Septic Tank YES NO     Town Sewer Oil Tank YES NO