| Note Holder's Name(if more than one, list all names) |
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| Note Holder's Email Address |
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| Contact Phone |
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Contact Fax |
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| Note Payor's Name |
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Mortgage Information Worksheet
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| Property's Original Sales Price |
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Down Payment |
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| Note's Monthly Payment |
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Note's Term |
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| Note's Original Balance |
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Note's Current Balance |
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| Note's Interest Rate |
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Fixed |
Variable |
| Date of Note's First Payment |
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Is This Note Current? |
Yes No |
| Number of Note Payments Made |
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Payments Remaining |
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| Is There a Balloon Payment? |
Yes |
No Balloon |
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| If a Balloon, what is the Amount? |
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Balloon's Due Date |
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| Note's Lien Position |
First Position Lien |
Second Position Lien |
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| Property's Appraised Value |
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Appraisal Date |
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| Is there a Title Policy? |
Yes No |
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| Property is Currently... |
Owner Occupied Renter Occupied Vacant |
| Property Description |
Single Family Duplex Triplex / Fourplex Mobile Home |
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Commercial Vacant Land Special Purpose / Other |
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Required*
Address of Property including City, State, and Zip
Please Indicate which one of the following Security Instruments was Used to Secure this Owner Financed Loan:
(Mortgage & Note, Land Contract & Note, Trust Deed & Note or Contract for Deed)
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| Credit of Payor if known |
Excellent Good Fair Poor Unknown |
| Is the Payor in the Armed Forces? |
Yes No |
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| If "Yes", is Payor deployed? |
Yes No |
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| Quote type request |
Entire Note Balance Balloon Balance Give Me Some Options |
| Additional quote request information such as amount of funds required and why you are selling the note. |
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| Please answer the math question. The sum of 9 + 3 = |
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