CONTACT INFORMATION
*First Name:
*Last Name:
*Email:
*Daytime Phone:
*Evening Phone:
Fax:
*City:
*State:	(choose one) Illinois Indiana Wisconsin
PROPERTY INFORMATION
*Your Interest in the Property:	(pick one) Owner Family Member Contract Holder Wholesaler
*Type of Property:	(pick one) single family 2 flat 3 to 4 unit Other
*Condition of Property:	(pick one) Distressed Below Average Average Above Average
*Brief Description of Property:
*Who lives in Property:	(pick one) Owner Tenant Vacant
*Property Address:
*City:
*State:	IL (only)
*Zip:
*Reason for Sale:
*Is Mortgage Current:	(pick one) Yes No Foreclosure