First Name:  *

Last Name:  *

Your Time Zone:  *

Best Time To Call You Back w/Quote:  *

(Area Code) Phone Number:  *

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:  *

Present Zoning:  *

Property Address:  *

City:  *

State: Select One:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyoming

Zip Code:  *

Describe 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:  *

Payment Frequency: MonthlyQuarterlySemi-AnnualAnnualOther

Term of Note (in Months):  *

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 the amounts of any junior position (2nd or 3rd) liens.

Reason for selling your note:  *

What type of purchase are you interested in? Full Purchase Partial 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 supply 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

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