Seller information

First name:  I:  Last Name:

E-mail:Phone:

Note type

Type of note:       Real Estate:Business:Other:Please Describe:

Real estate information

Street address: City:State:County:

Residential: Commercial:Land:                   Brief description:

Current Estimated Value:

Note information

Date of sale:     Selling price:     Date of note:     Note amount:

Terms (in months):       Interest rate:       Balloon amount:      Balloon date:

Down payment:Payment amount: Date of First Payment:Number of payments paid:

Next payment date:First Lien (Yes or No):

Balance:          Additional information about the payor and the note: