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Contact Information

The Person filling in this form is: (required)
The Note HolderRelative of Note HolderFriend of Note HolderEmployee of Note HolderBroker

Name: (required)

Email: (required)

Address: (required)

City: (required)

State:
ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY

Zip: (required)

Day Time Phone: (required)

Night Time Phone:

Mobile Phone:

When is the best time to contact you:

Are you personally receiving payments on this note:
—Please choose an option—YesNo

Note Information

What type of Lien Instrument is this:
—Please choose an option—MortgageDeed of TrustLand Sales Contract (Contract for Deed)All Inclusive MortgageAll inclusive Deed of TrustOther (Explain in Description)

Type of Property:
—Please choose an option—Single Family ResidenceMulti UnitCommercial BuildingMobile HomeVacant LandOther (Explain in Description)

Please Provide A Description Of The Property And Surrounding Area:

Payer's Credit Score:

Property Value:

How Did You Arrive At That Value:

Owner Occupied:
—Please choose an option—YesNo

Sales Date:

Sales Price:

Down Payment:

Was Down Payment Made in Cash:
All CashOther (Explain in next field)

Down Payment Other Details:

Face Value of Note For Sale:

Note Balance:

Interest Rate:

Payment Amount:

Payments Made:
MonthlyQuarterlySemi AnnuallyAnnuallyOther

Number of Payments Made:

1st Payment Due Date:

Payments Remaining:

Next Payment Due Date:

Loan to Value %:

Are Payments Current or Delinquent:
Select OneCurrentDelinquent

LIs There A Balloon Payment:
Select OneYesNo

If Yes, How Much Is The Balloon Payment?:

When Is The Balloon Payment Due:

Position of Note:
Select One1st2nd3rdOther

1st - Remaining Balance:

2nd - Remaining Balance:

How Much Do You Expect To Get For This Note:

When Do You Need It By:

Other Information: Please provide any additional information that would assist us in preparing an accurate quote, such as whether the interest rate is adjustable, whether future payment amounts may change, the acreage on lots that exceed five acres, the type of businesses located on commercial property, etc.:

Please leave this field empty.