First Name:  * Last Name:  * Best time to call you back with a 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: Mobile Home W/LandSingle Family ResidentialCondoTownhouseDuplexTriplexFourplexCommercial PropertyLand (improved)Land (unimproved) If mobile home what year was it manufactured: If mobile home what is the make and model: Property address: City: State: Select One:AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyoming Zip code:  * Fully describle the property (3 bedroom 2 bath etc...):  * Note Payors Information: Note payors full name:  * Note payors current 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 OccupiedTenant Occupied Date of sale:  * Sale price:  * Down payment:  * Beginning balance (1st lien):  * Beginning balance (2nd lien): Date 1st payment was due:  * Date next payment is due:  * 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: YesNo Balloon payment due date: Amount of balloon payment: What is the approximate value of the property:  * Special clauses or comments: Reason for selling note:  * List amounts of any junior position lien:  * 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 Deed of Trust Mortgage or Contract NoYes Escrow closing statement (HUD-1): NoYes Existing title insurance policy: NoYes Recent appraisal of property: NoYes Current hazard insurance policy: NoYes Payment history: NoYes Can you supply a photo of 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 this trancaction within the next 30 days: No Yes Security code:   * Do not enter anything in this field:

* indicates a required field