Contact Information  

I am the note:

Select OneOwner/SellerBrokerRealtor

First Name

Last Name

Address

City

State

Zip Code

E-Mail

Phone

( )

Fax

( )

Payor (s)  Information

First Name 

Last Name 

Credit

Select OneABCDUnknown

Credit Score

SSN

Property Information

Address

City

State

Zip Code

Property Type

Select One1-4 SFRMulti-Unit 1-4 SFRMulti-Unit Apts > 5Mobile Home Single-Wide W/LandMobile Home Double-Wide W/LandMobile Home Single-WideMobile Home Double-WideLandCommercial

If Mobile, Year

MH Legally Fixed?

Yes No

If Land, # of Acres

Land Improvements

Occupied By

  Select OneOwnerRentalVacant

Sales Price

$

Date Of Sale

Down Payment

$

Estimated Value

$

Value Arrived  By

  Select OneMarket ValueAppraisalRealtor

Payment History

  Select OneOn Time1-5 Late Pays5-10 Late PaysOver 10 Late PaysNone Recieved

Date of 1st Pay

Date of Next Pay

Please provide any additional comments on the
property that will aid in the sale of your mortgage note.

If Commercial Property describe monthly cash flow
and age of buildings.

Mortgage Note Information

This Note is a:

  Select One1st Lien2nd LienWrapReal Estate Contract

1st  Mtg Amount:

$

2nd Mtg Amount:

$

Original Balance

$

Term (months)

Payment Amount

$

Interest Rate

  %

Current Balance

$

Payments Left

Balloon Payment?

Yes No

Balloon Amount

$

Balloon Date Due

Comments 

Why Are You Selling?
(This helps us understand your needs.)

Comments or Questions?

If not selling your whole note, how
much cash do you need ?

$