MORTGAGE NOTE INFORMATION FORM

Please supply as much of the information as possible. Don't hesitate to contact us if you need assistance.


Mortgage Note Submission Form
Please note that all fields followed by an asterisk must be filled in.
Note Seller's Name*
E-mail Address*
Home PhoneBusiness Phone

Property & Lien Information
Property Address
Lien Position
First Lien Mortgage/Deed of Trust
Second Lien Mortgage/Deed of Trust
Contract for Deed/Land Contract
Wrap-around mortgage
 Property Type
Single-Family Detached
Single-Family Attached
Duplex
3-4 Unit
Mobile Home (Affixed)
Farm/Ranch
Land Only
Commercial/Multi-Family
Occupancy
Owner Occupied
Non-owner Occupied
Location
Urban/Suburan
Rural

Current property valueHow was this value determined (appraisal, realtor, etc.)Appraisal Date (if applicable)
If mobile home
Mobile home typeYear builtDimensions
Single-Wide
Double-Wide
Transaction & Note Information
Sales PriceSales DateDate of note origination
Cash Down PaymentFirst mortgage $Second mortgage $
Face amount $Term (Months)Monthly payment (P&I)
Current balanceInterest Rate %First payment due date
Next payment due date# Payments Made# Payments remaining
Are payments current?Balloon term (Months)Balloon $
Yes
No
Name of note payor
Any late payments within last 12 months?
Yes
No
Please explain any known credit problems
Please provide any additional information here

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