There is no cost or obligation, so please provide accurate information in order to receive your evaluation quickly.

Your Contact Information  (Please complete all fields)   First Name: Last Name: Cell Phone: Daytime Phone: Evening Phone:   EMail: Street Address: City: State/Province: Zip/Postal Code:

Are you looking to evaluate your homes value for the purposes of selling or refinancing?     Selling Refinancing If you are planning to sell your home, will it be within the next 6 months?     Yes No

Description of the home you wish to sell:

Style of Home:  (eg. 2 levels, 1 level, bungalow, backsplit, etc.)   Type of Home   Colonial Bi-Level Cape Cod Ranch Contemporary Condo/Townhouse Other Approximate Square Footage of Home:   Lot Size: ft. Frontage x  ft. Depth Location:   Type of Heating:   GAS OIL ELECTRIC OTHER Type of Air Conditioning:   Central Air Window Unit Wall Unit OTHER Number of Bedrooms:   1 2 3 4 5 More Number of Bathrooms:   1 1.5 2 2.5 3 3.5 4 More Fireplaces:   YES NO MULTIPLE Basement Description:   Full/Finished Full/Un-Finished Partial Unfinished   On a scale of 1-10 (with 1 being Poor and 10 being Exceptional), please rate the showability of your home: Poor 1 10 Exceptional   Special Features: