Date

    1: Contact Information
    Name:
    Address:
    Zip/Postal Code:
    Email:

    Home Phone:

    Cell Phone:

    2: Appliances & Personal Property
    Age of Appliances Gas or Electric
    Stove

    		Will this remain in the home after the sale?

    Fridge Will this remain in the home after the sale?

    Microwave Will this remain in the home after the sale?

    Dishwasher Will this remain in the home after the sale?

    Washer

    		Will this remain in the home after the sale?

    Dryer

    		Will this remain in the home after the sale?

    Water Heater

    Furnace

    A/C Unit
    Other
    Is there a propane tank on the property?

    If yes, is the tank rented or owned?
    Please provide the name of the propane service provider:

    3: Utilities
    Type Name of provider Average Utility Bill
    Electric
    Gas
    Water
    Sewer
    Internet
    Television
    Telephone
    Provide the name of the security system and company, if applicable
    Is there a septic system on the property?

    Please state the location of the septic field and the last date of service on the septic system:
     

    4: About Your Home
    Please list any updates made to your home in the last 5 years:
    Why did you choose this home when you were buying?
    Favorite things about the location and/or neighborhood?
    Please list anything else you want buyers to know about your home:

    5: Miscellaneous
    List any easements on the property:
    Is the property on a private road? If yes, is there a written road agreement in place?
    Is there a homeowner association? If yes, please provide the contact info, dues, frequency and the date current dues expire:

    6: Showings
    Are there times that you will not be able to accommodate showings?

    If you answered yes, please explain:
    Are there pets that will be home during showings?

    If you answered yes, will the pet be contained? Please provide details here:
    What is the best way to notify you of showings?

    What number should we text/call?

    6: Lender/Servicer
    Name of Lender:
    Account #:
    Approximate Payoff: