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:	Single Family ResidentialCondoTownhouseDuplexTriplexFourplexMobile Home W/LandCommercial PropertyLand (improved)Land (unimproved)
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:	*
Fully describe the property (3 bed 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 payment:	YesNo
Balloon payment due date:
Amount of balloon payment:
What is the approximate value of the property:	*
Special clauses or comments:
Reason for selling your note:	*
List amounts of any junior position liens:
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 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 this transaction within the next 30 days.	NoYes

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