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  1. Note Seller's Name:

    Name

  2. Seller's Phone Number:

     Phone

  3. Seller's E-Mail Address:

    E-mail

  4. Type of Property:


  5. Property Address of Note:

    Street Address
    City/ State
    Zip/Postal Code

  6. Date of Sale :

    -- mm/dd/yy

  7. Date of First Payment :

    -- mm/dd/yy

  8. Appraised Value:


  9. Original Sales Price:


  10. Down Payment Amount:


  11. Interest Rate:


  12. Payment Amount:


  13. Term of Note (months)


  14. Number of Payments per Year:


  15. Next Payment Date :

    -- mm/dd/yy

  16. Payers Credit:


  17. Owner Occupied

    Yes No

  18. Payments Current:

    Yes No

  19. Position of Note:


  20. Remaining Balance:


  21. Balloon Payment:

    Yes No

  22. Balloon Amount:


  23. Balloon Due Date:

    -- mm/dd/yy

  24. Comments:


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