First Name

Last Name

Email Address

Phone Number

Best Time to Contact You

Property Street Address

Property City

Property State Property StateAlabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois

Property Zip Code

Type of Property Type of Property Residential - Single Family Home Duplex/Triplex Land Multi- Units Commercial Other

Year of Construction

Bedrooms Bedrooms 1 2 3 4+

Bathrooms Bathrooms 1 2 3+

Living Space Square Footage

Air Conditioning Air Conditioning None Wall/Window Central

Garage Garage Yes No Double

Basement Basement None Finished Semi-Finished Not Finished

Repairs to be Done Repairs to be Done Yes No

If repairs are needed, please describe all repairs and renovation to be done and estimate dollar amount.

Is there a mortgage on the property? Is there a mortgage on the property? Yes No

Mortgage Balance

Is your property currently listed by an agent? Is your property currently listed by an agent? Yes No

Date - When do you need (or want) to move?

Why do you need to sell?

Other Comments

Would you like to receive SMS notification from O & H Prosperity Group, LLC about this property? Would you like to receive SMS notification from O & H Prosperity Group, LLC about this property? Yes No