Survey Form

Location/Area

Year of Purchase

Estimated Value

Choose... less than $100,000 $100,000 - $200,000 $200,000 - $400,000 $400,000 - $600,000 $600,000 - $800,000 $800,000 - 1 Million 1 Million+

First Mortgage Interest Rate

Choose... 2% - 4% 4% - 6% 6% - 8% 6% - 8% 8% - 9% 9% Plus

First Mortgage Balance

Choose... less than $100,000 $100,000 - $200,000 $200,000 - $400,000 $400,000 - $600,000 $600,000 - $800,000 $800,000 - 1 Million 1 Million+

Property Use As

Choose... Primary Home Secondary Home

Second Mortgage

Choose... YES NO

Additional Cash

Monthly Income

Choose... $2500 - $4000 $4000 - $6000 $6000 - $8000 $8000 - $10,000 $10,000+

Monthly Expenses

Choose... $2000 - $4000 $4000 - $6000 $6000 - $8000 $8000 - $10,000 $10,000+

Proof Of Income

Choose... YES NO

Bankruptcy in Last 3 Years

Choose... YES NO

Have FHA Loan

Choose... YES NO

Late Mortgage Payments

Choose... YES NO