First Name:  * Last Name:  * Your Time Zone:  * Best Time To Call You Back w/Quote:  * (Area Code) Phone Number:  * Fax: Email Address:  * Your Address:  * Your City:  * State: Select One:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyoming Zip Code:  * Property Information: Property Type:  * City:  * State: Select One:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyoming Zip Code:  * Fully Describe the Property:  * What is the Highest & Best Use?  * What improvements have been made to the property?  * Note Payors Information: Note Payors Name:  * Note Payors Address:  * Note Payors Credit is Believed to be: A - ExcellentB - GoodC - Below AverageD - Poor Receivable Information: Receivable Type: Note & MortgageNote & Deed of TrustLand ContractContract for DeedOther If Other Please Specify: Note Lien Position: 1st2ndAll-Inclusive Wrap Note Status: CurrentDelinquent Date of Sale:  * Sale Price:  * Down Payment:  * Beginning Balance (1st lien):  * Beginning Balance (2nd lien): Date 1st Payment was Due:  * Next Payment Due Date:  * Payment Amount:  * Term of Note (in months):  * Payment Frequency: MonthlyQuarterlySemi-AnnualAnnualOther Interest Rate:  * Current Balance (1st lien):  * Current Balance (2nd lien): Number of Payments Made:  * Number of Payments Remaining:  * Is there a Balloon Payment: NoYes Balloon Due Date: Amount of Balloon: What is the approximate value of the property:  * Special Clauses or Comments: List amounts of any junior position (2nd or 3rd) liens. Reason for selling your note:  * What type of purchase are you interested in? Full PurchasePartial Purchase Is there a specific dollar amount you need to raise?  * Do you have and can you supply copies of the following documents? Note and Deed of Trust Mortgage or Contract: NoYes Escrow Closing Statement: NoYes Payment History: NoYes Title Insurance Policy: NoYes Recent appraisal of the property? NoYes Current Hazard Insurance Policy: NoYes Can you provide a photo of the property: NoYes What is your relationship to this transaction: Note Holder/SellerNote Broker/Note FinderMortgage Broker/Loan OfficerRealtor/AgentAttorney/CPA/Fin. PlannerEstate RepresentativeFamily/Friend I am ready for a free quote and if your offer meets my approval I am ready to close the transaction within the next 30 days: YesNo Security code:   * Do not enter anything in this field:

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