First Name Last Name Email Cell Phone Fax Subject PROPERTY/DEBTOR INFORMATION: Property Type —Please choose an option—Single Family HomeMulti-Family HomeMobile Home With LandLand OnlyCommercial BuildingCommercial Land OnlyOther Property Description (optional) Occupancy Status—Please choose an option—Owner OccupiedNon-Owner OccupiedOther Property Address Address Line 1 Address Line 2 City State—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Other Information (optional) Other information that you feel is pertinent to the value. Credit Score NOTE INFORMATION: Sales Price Current Loan Balance Down Payment Interest Rate Length Of Note Number of Payments Per Year Balloon Amount Date Of Balloon Date Sold First Mortgage Second Mortgage Date Of First Payment Payment Amount Balloon —Please choose an option—YesNo Next Payment Due Payment History—Please choose an option—Perfect Pay/Never LateSometimes Pays 15 to 30 Days LateSometimes Pays 30 to 60 Days LateConsistently Pays 15 to 30 Days LateConsistently Pays 30 to 60 Days Late
