PHONE ( ___ ) ___________ FAX ( ___ ) ___________

PROPERTY INFORMATION
COUNTY : ____________ CITY :_______________ STATE : ____________
STREET ADDRESS IF AVAILABLE : ___________________________
CURRENT ESTIMATED VALUE: $ __________________

IS THE PROPERTY Residential : Commercial : Owner Occupied : Rental :

DESCRIPTION OF REAL ESTATE PROPERTY & AREA

____________________________________________________________________________________

HISTORICAL INFORMATION
DATE OF SALE : _____________

SELLING PRICE $ ___________

DOWN PAYMENT $ ___________

1st MORTGAGE $ ___________

2nd MORTGAGE $ ___________

NOTE INFORMATION
DATE OF NOTE : ________________

AMOUNT $ ________________

TERM IN MONTHS ________________

PAYMENT AMOUNT $ ________________

BALLOON AMOUNT $ ________________

BALLOON DATE ________________

INTEREST RATE ___%

DUE DATE 1st PMT ________________

# OF PAYMENTS PAID ________________

# OF PAYMENTS LEFT ________________

NEXT PAYMENT DUE ________________

BALANCE $ ________________