Note Quote Submission Form

1. For your benefit, please enter all information as completely as possible.
2. All quotes are subject to payor credit, appraisal, title and underwriting review.
3. We will contact you with a quote within 1-2 business days or to request further information as necessary.

If you prefer, you may submit this form by printing and faxing to 765-768-4133.

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Contact Information

Your Name (First & Last):
Your Street Address:
Your City:   State:   Zip:
Home Phone #:   Work Phone #:
Best Time to Contact:
Fax Phone #:
Your E-mail Address:

Payor Information: (the note payor)

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

                                            Credit Of The Payor:
                  A   B   C   D   Unknown

Note Information: (this is the minimum information necessary for evaluation of your note)

Original Note Amount: $
Current Note Balance: $
Interest Rate: % Note Term:
Monthly Payment: $
Balloon Payment: $   Balloon Due Date:
First Payment Due Date:
Number of Payments Made:
Number of Payments Remaining:
Next Payment Due Date:
Are Payments Current?:

Property Information:

Selling Price: $   Down Payment: $  
Property Address:   City:   State:   Zip:
Property Type:   Position of Note:

*** If this note is Junior to another loan(s),
What is the approximate balance on the senior loan(s)? $

Please Select the Statement Below That Best Describes Your Interests.

I may consider selling only a portion of the note to meet my financial needs.
I am only interested in selling the whole note and getting the most cash I can.


Additional Information or Comments:


How did you find us?

Thank you for the opportunity to evaluate your note. We will respond to you within 1-2 business days.

Referred By: (for Affiliate or Broker use)





To Submit Worksheet Press:

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