Please provide the following contact information: (*denotes required information for a quote)

Name*
Title
Organization
Home Phone
FAX
E-mail*

Please check one:            Note Holder (receiving payments on a note)        

                                       Note Broker

                                       Note Finder     

Choose one of the following options*:

Deed of Trust Mortgage Contract for Deed Land Contract Other

Select the Property Type*:

           Single Family Home Singlewide Mobile Home newer than 2000 Singlewide mobiel home older than 2000 Doublewide Mobile Home newer than 2000 Doublewide Mobile Home older than 2000 Condominium Townhome Duplex Triplex 4-plex Multi Family Units (5 units or more) Commercial Property Land Only

Please provide a short description of the property (bedrooms, bathrooms, type of commercial property, raw land, improved land, etc.*:

When did you (the seller of the property and now note holder) purchase the property and for how much?*:

Where is the property located? (complete and exact address of property including zip code)*

What was the selling price of the property?*

How much down payment?*

How much is the first mortgage?*

How much is the second mortgage?

Enter the original date of the mortgage:

-- mm/dd/yy

What was the amount of the original mortgage?*

For how many months (term)?*

What was the interest rate?*

How much is the monthly payment?*

What is the current balance?

Enter the date of the first payment:*

-- mm/dd/yy

Who is collecting the payments?*:

           Seller/Note Holder Servicing Company Title Company Attorney Escrow Company

How many payments have been made?*

How many payments are left?

Enter the date of the next payment due:

-- mm/dd/yy

How much is the balloon payment?

Enter the date of balloon payment:

-- mm/dd/yy

Are there any underlying mortgages to be paid of? If so please enter approximate amount of underlying.

Does the buyer have good credit?*

Yes No Unknown

Comments (write as much as you would like):

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