First Name  Last Name
Address
City State Zip
Phone # (555-555-5555)
eMail Address

Number of Bedrooms:
Number of Bathrooms:
Interior Square footage:
Lot Square Footage:
Year Built:
Is your home on a busy street? Yes   No
Are you in a noisy area? Yes   No
Does your home have a view? Yes   No
Rate the condition of your home on a scale of 1-10 with 1 being the worst and 10 being the best.
Have you done any remodeling in the past 5 years?  If yes, describe. Yes   No

Is there anything else you would like to tell me about your home before I perform an estimated market value analysis?