Note Seller's Name:________________________________ Date: _______________

Seller's Address: _______________________________________________________ (street, city, state, zip)

Seller's Phone: _______________________

PROPERTY INFORMATION (if Applicable)

Property Address: ______________________________________________________ (street, city, state, zip)

Type of Property: _______________________ Owner Occupied: _________________

Sale Price: __________________ Date of Sale: _________________

Property Value: $_________________ Established by Sale/Other: ________________ Date: __________________

1st Loan Amount: $__________________ Monthly Payment: $_______________ New/ Assumed

2nd Loan Amount: $__________________ Monthly Payment: $_______________ New/ Assumed

Down Payment Amount: $__________________ LTV: _______________% ITV ______________%

Type of Note: ___________________________________________________________________________

Original Amount: $___________________ Balance $__________________ As of: ____________________

Interest Rate: _________________% Payment Amount: $___________________ Date of 1st Payment: _____________

Original Length: _____________ (# of Months) Type: __________________ (Amort, I/O, Other)

Number of Payments Made: ______________ Number Remaining: ______________

Are the payments on time: _______________ What day of the month are they due: __________________

Balloon Payment (if any): $______________________ Balloon Payment date: ___________________ (if Applicable)

Are there any clauses: _____________________________________________________________________________

SELLER INFORMATION

Note Seller's Motivation: ____________________________________________________________________________

When do you need to close: _____________________ Received any other offers: ___________________________

What does the note payor do for a living: ________________________________________________________

Payor's credit score: _______________________________________

Any other miscellaneous items of interest regarding this note: _______________________________________________ __________________________________________________________________________________________________