Your Name (First & Last):
Your Street Address:
Your City: State: Zip Code:
Daytime Phone #: (area code first)
Evening Phone #: (area code first)
Fax Phone #: (area code first)
Your E-mail Address:

Name of Borrower(s):
Address: City: State:
Zip Code: *** SSN #: ***(This is very important for an accurate quote. If you have any questions regarding this, please note below or call us).

The information requested below is the minimum necessary for evaluation of your note.

Original Face Amount: $
Current Balance: $
Interest Rate: % Note Term:
Monthly payments: $
Balloon payment: $ Balloon Date:
Date of 1st payment:
Total number of payments made to date:
Number of payments left:
Next payment Due:
Are the payments current? - - > Select: Please Select Yes No
Who keeps track of the payments? - - > Select: Please Select Me Loan Servicer Title Company Bank Other

Now about the property...

Selling Price: $ Down Payment: $
Sale Date:
Property Location: Current Value: $
Property Type --> Select: Please select a type Owner Occupied SFR Single Family Rental Duplex - Fourplex 5 Units or more Commercial Mobile Home on Deeded Land Mobile Home in Park Land
Position of Note - - > Select : Select First Lien Second Lien Third Lien Other
*** If this note is Junior to another loan(s),
(A) What is the approximate balance on the senior loan(s)? $
(B) What is the approximate monthly payment on the senior loan(s)? $

Your estimated cash requirements: $
( You may not need to sell the entire note... when a partial sale will meet your needs! )

Additional Information / Comments:

Thank you for the opportunity to evaluate your note. We will respond to you shortly!