Mortgage Note Quotation Form

Note Holder's Name
Note Holder's Email Address
Contact Phone		Contact Fax

Mortgage Information Worksheet

Property's Original Sales Price		Down Payment
Note's Monthly Payment		Note's Term
Note's Original Balance		Note's Interest Rate
Note's Interest Rate is	Fixed	Variable
Date of Note's First Payment		Is This Note Current?	Yes No
Number of Note Payments Made		Payments Remaining
Is There a Balloon Payment?	Yes	No Balloon
If a Balloon, what is the Amount?		Balloon's Due Date
Note's Lien Position	First Position Lien	Second Position Lien
Property's Appraised Value		Appraisal Date
Is there a Title Policy?	Yes No
Property is Currently...	Owner Occupied Renter Occupied Vacant
Property Description	Single Family Duplex Triplex / Fourplex Mobile Home
	Commercial Vacant Land Special Purpose / Other
Additional property Information such as age, condition, type of Neighborhood. Are you Including any photographs?
Credit of Payor if known	Excellent Good Fair Poor Unknown
Is the Payor in the Armed Forces?	Yes No
If "Yes", is Payor deployed?	Yes No
Quote type request	Entire Note Balance Balloon Balance Give Me Some Options
Additional quote request information such as amount of funds required and why you are selling the note.

Please answer the math question. The sum of 9 + 3 =

Mortgage Information Worksheet