Mortgage Note Quote Request	If you prefer not to submit this form online, Please fax to 610-879-3732
	It is strongly suggested that you also fax a copy of the actual promissary note/relevant document(s) to receive the most accurate quote possible
Full Name (required):
Phone Number(s) (required):
Date:
Email Address:
How did you hear about us?:
Does Note Belong To You Personally? If No, Please Explain:
Original Selling Price:
Down Payment:
Original Note Balance:
Months or Years Financed:
Interest Rate:
Monthly Payment Amount:
Balloon:	Yes      No
If yes: Date of Balloon:
If yes: Amount of Balloon:
Date of First Payment:
Remaining # of Payments:
Current Balance:
Current Appraised Value:
Owner Occupied:	Yes      No
Underlying Balance:	Yes      No
If yes: Underlying Balance Amount:
Note is 1st position lien and only lien/mortgage on property?:	Yes      No
If NO: Please explain:
Credit Class of Payer:	Excellent Good Bad - Less than 625 Unknown
Credit Score of Payer (Numeric). This is very helpful in providing an accurate quote to you:
Have any extra/unscheduled payments been made? Have any payments been missed? If so, please describe:
Property Type:	Single Family ResidentialDuplex/Four-plexCondo/Townhouse Mobile Home Single - with land Mobile Home Double - with land Commercial Land Only/Unimproved Land with improvements Other - Please specifiy below
If Other, please specify:
Property Age:
Security Agreement:	Deed of Trust Mortgage Land Contract Contract for Deed Other - please specify below
If Other, please specify:
Title Policy (answer required for most accurate quote):	Yes      No
Property Description and Address (City and State are needed at minimum):
Additional Comments/Requests - If you would like a quote on selling only a limited number of payments and/or only part of the monthly payment, or would like a specific amount of money please indicate such here: