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First Name

Last Name

Postcode / Zip

Town / City

Street Address 1

State / Province

Landline

Mobile Phone

Estimated property value (i.e. £180,000)

Number of bedrooms

Number of bathrooms

Does the property have a garden, garage or storage?

Yes No

Type of property

What is the general condition?

If Leasehold, how many years are remaining?

Outstanding mortgage balance

Any loans secured on the property, not already included in the mortgage balance?

How soon do you need to complete?

What is the reason for selling?

Any additional information?

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