First Name:  *

Last Name:  *

Your Time Zone:  *

Best Time To Call You Back With a Quote:  *

(Area code) Phone Number:  *

Email Address:  *

Your Address:  *

Your City:  *

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

Zip Code:  *

Property Information:

Property Type: Single Family ResidentialCondoTownhouseDuplexTriplexFourplexMobile Home W/LandSeasonal or VacationOther

If mobile home what year was it manufactured?

If mobile home what is the make & model?

Property Address:  *

City:  *

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

Zip Code:  *

Describe Property (3 bed 2 bath etc...):  *

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

Is the Property Owner or Tenant Occupied: Owner Occupied Tenant Occupied

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:

Reason for selling your note:  *

List amounts of any junior postion liens:

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

Title Insurance Policy? NoYes

Recent appraisal of the property? NoYes

Current Hazard Insurance Policy? NoYes

Payment History ? 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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