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I am the : |
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Owner
Lender
Agent |
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Full Name: |
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Business Name: |
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Address: |
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City: |
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State: |
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Zip: |
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Home Phone: |
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Work Phone: |
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Mobile Phone: |
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Fax: |
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Email Address: |
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Property
Information |
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Address: |
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City: |
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State: |
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Tax ID / PIN #
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Number of Structures On-Site: |
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Number of Dwelling Units: |
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Is This Property
Vacant/Distressed? |
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Yes
No |
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Reason for Vacancy/Distress: |
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Expected Length of
Vacancy/Distress: |
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Indefinite
Temporary |
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If Distressed, Approximate Date
of Vacancy: |
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Date of Expected Occupancy: |
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Is Building Secured? |
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Yes
No(If
YES, check below) |
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Insurance Carrier: |
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Policy Number: |
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Liability Limits: |
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Property
Status |
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If property
is under contract, please answer
below. |
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Anticipated Closing Date: |
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Purchaser Contact Information |
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Full Name: |
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Address: |
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City: |
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State: |
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Zip: |
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Home Phone: |
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Work Phone: |
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Email Address: |
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