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Tell Us About You:
Full Name:
Your Address:
City, State, Zip:
Home Phone:
Mobile Phone:
E-Mail:
Are you the note seller:	Yes No
Tell Us About the Property:
Property Type:
Property Description:
Property Address:
Location: (City, State, Zip)
Property Value:
Occupancy:
Sale Date:		Calendar
Sale Price:
Down Payment:
Tell Us About the Payor:
Buyers Name:
	Individual Payor Corporate or LLC
Payors Credit:
Are All Payments Current:
Has payor been 30 days or more delinquent in the Last 12 months:
If yes how often:
Tell Us About your Note:
Face Value of Note:
Present Note Balance:
Interest Rate:
Payment Amount:
Schedule of Payments:
How Many Payments Made:
How Many Payments Remain:
1st Payment Made On:		Calendar
Next Payment Due:		Calendar
Loan to Value:
Is there a balloon payment:	YesNo
Balloon Payment Amount:
Balloon Payment Due:		Calendar
Position Of Note:
Tell Us What is your expectation:
What would you like to accomplish selling your note:
Comments:

Thank You!