Form

Cover Letter
Tell us everything you know about the note:*
Broker Information
The Broker Information section only needs to be completed if a broker is submitting the note on behalf of their client.
Broker name:
First Name Last Name
Company:
Title:

Broker Address;

Broker Phone:
- Area Code Phone Number
Broker Fax:
- Area Code Phone Number
Broker Email:
Are you in direct contact with the note holder?:
We require that you be in direct communication with the note holder. We do not entertain broker/daisy chains.
Contact Information of Note Holder
Client name:*
First Name Last Name
Company Name:
Title:

Client Address:*

Address:*

County:*
Current Estimated Value:*
Based On:*
Residential:*
Commercial:*
Description:
If Commercial choose of these options:
Description of Real Estate Property and Area:*
Historical Information
Date of Sale:*
Selling Price:*
Down Payment:*
First Lien:*
Second Lien (If applicable):
Note Information
Date Note was created:*
Amount the note was created for:*
Term in Months Amortization:*
Balloon:*
Balloon Amount:*
Balloon Date:*
Interest Rate:*
Payment Amount:*
Date of 1st Payment:*
# of Payments Made:*
# of Payments Left:*
Next Payment Due:*
Balance Remaining :*
Prior Mortgage Information (if any):
Prior Mortgage Information:*
Payor Information
Employment Info, Payment History, SS#*
Sellers Motivation/Need
Motivation/Need to sell:*
How much do you need to liquidate this note?:*
I have copies of the following
The following items do not need to be sent right now. Only when an offer is made and accepted.
Note:*
Security Instrument:*
Title:*
Sales Contract:*
Payor Credit Report:*
Closing Statement:*
Bill of Sale:*
Insurance:*
Lease:*
Prior Mortgage Information:*
Payment History:*
Enter the code as it is shown:*
Should be Empty:

Cover Letter