PROPERTY INFORMATION

* = required

* Street Address :

* City :

* State : CT MA RI

* Zip Code :

* County : CT - Fairfield CT - Hartford CT - Litchfield CT - Middlesex CT - New Haven CT - New London CT - Tolland CT - Windham MA - Barnstable MA - Berkshire MA - Bristol MA - Dukes MA - Essex MA - Franklin MA - Hampden MA - Hampshire MA - Middlesex MA - Nantucket MA - Norfolk MA - Plymouth MA - Suffolk MA - Worcester RI - Bristol RI - Kent RI - Newport RI - Providence RI - Washington

* What Type Of House ? Single Family Multi-Family (2-4 units) Townhouse/Rowhome Condo Mobile Home Other

Total No. of Rooms :

* No. of Bedrooms :

No. of Bathrooms :

No. of Kitchens :

* Square Feet (Living Area) :

* Taxes :

For above info, what was source of info ? Tax Records MLS/Broker/Agent Zillow Owner Other N/A

* Is property vacant ? Yes No Unknown

* Is property currently listed for sale ? Yes No Unknown

If answered yes, listing type : By Owner By Broker/MLS Other Unknown N/A

If for sale, what is the asking price ? (enter numbers only, no commas)

If MLS listing, what is the MLS # ?

How would you describe the neighborhood ?

Comments or Additional Info :

OWNER INFORMATION

Owner Name(s) :

Address :

City :

State : AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY N/A

Zip Code :

Phone Number :

E-mail Address :

Comments or Additional Info :

REPAIR ESTIMATES

* After Repair Value (ARV) : (enter numbers only, no commas)

ARV Source : Tax Records Realtor comps Zillow Other N/A

* Repairs needed ? Yes No Unknown

If answered yes,

What is gross square footage ?

Gross Square Footage Source : Tax Records MLS/Broker/Agent Zillow Owner "Guesstimate" Other N/A

What is your repair estimate ? (enter numbers only, no commas)

Repair Estimate Method : "2-D" - sq ft multiplier method "3-D" - sq ft multiplier method "3-D" - itemized list method Other Unknown

Details about how this estimate was determined :

Foundation Condition :

Garage Condition (if applicable) :

Comments or Additional Info :

RENTAL ESTIMATES

(Single family and 2-4 unit multi-families)

* Fair Market Rent (FMR): (enter numbers only, no commas)

FMR Source : HUD Fair Market Rents Realtor comps Zillow Other N/A

If multi-family, FMR above is total rent for all units. Please list total # of rooms, # of beds, # of baths, square footage and Fair Market Rent (FMR) for each unit on the table below:

Comments or Additional Info :

PROPERTY SCOUT INFORMATION

* Lead Submitted By :

Phone Number :

* E-mail Address :

Questions, Comments or Additional Info :

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