Seller's Personal Information

Name:			Email Address:
Address:
Address:
City:			State:		Zip Code:
Phone Number:			Fax Number:

Note Information

Original Face Amount:			Contract Date:
Current Note Balance:			Term(months):
Current Interest Rate:			Fixed Adjustable
*If adjustable note, please state conditions:

Lien Position of Note: Select1st2nd3rd4th Interested in selling: All Part Either Minimum amount requested:

Balloons? Yes No IfYes, Amount: Due Date:

Seller's Comments:

About Property

Address:
City:		State:SelectAlabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New_Hampshire New_Jersey New_Mexico New_York North_Carolina North_Dakota Ohio Oklahoma Oregon Pennsylvania Rhode_Island South_Carolina South_Dakota Tennessee Texas Utah Vermont Virginia Washington Washington_D.C. West_Virginia Wisconsin Wyoming		Zip Code:
Nearest cross streets of property:
How is the property registered: Deed of Trust Contract for Deed
Legal Description: SelectSingle Family HomeTownhouseUnimprovedWarehouseCommercial BuildingMobile HomeCondominiumIndustrial BuildingMobile Home with LandTime ShareSingle Family Homes 1-6Apartments 1-40Apartments 40+Condiminiums 1-40LandImproved LandFarmRanchOffice BuildingStrip MallShopping Center			Status: SelectRentedOwner OccupiedVacantLeased
Land Information Land Type:SelectBuildable ResidentialLot including a road,water,sewer,electricityImproved exceeding 30% of valueLegally platted lot 1 acre or less *If improved land is the property, please select three improvements below: SelectStructureWater/WellRoadPowerFencingSeptic/SewerPlattingCropSelectStructureWater/WellRoadPowerFencingSeptic/SewerPlattingCropSelectStructureWater/WellRoadPowerFencingSeptic/SewerPlattingCrop Structure:SelectBarnStablesGargage Approx. Sq. Feet of Structure:
Market Value:			Based On: SelectLast Sale PriceRecent AppraisalValue at Origination
Location: Residential Commercial			Area Description: SelectRuralUrbanInnercitySuburbanCountryIndustrialOffice Park
Construction:SelectBlockBrickFrameSteel			Built: Sq. Feet:
Property Condition:Select A+AB+BC+CD+D			Insurance Paid:YesNo
Taxes Paid: YesNo			Pool: YesNo
*Please enter "seller" for applicable note holder.
Current First Note Position Balance:		First Note Holder:		First Note Payment Amount:
Current Second Note Position Balance:		Second Note Holder:		Second Note Payment Amount:
Current Third Note Position Balance:		Third Note Holder:		Third Note Payment Amount:
Selling Price:			Sold:
Down Payment From Buyer:			Owner's Equity in Property:
Property's Cummulative Loans to Value:

Payment Information

Payment Schedule:SelectAnnuallySemi-AnnuallyMonthlyQuarterlyBi-weekly		Payment Amount:
1st Payment Recieved:		Final Payment Date:
Number of Payments Recieved to Date:		Number of Payments Left:
Total Amount Received:
Important, final purchase price is subjected to credit evaluation of payor. Entering accurate information will help to avoid any potential adjustments to the final purchase price.
Track Record of Payment History: Current Late: 30 days60 days90 days

Payor's Payment Performance: