Your Name

Your Phone

Your Email

Date

1. Original Selling Price

2. Down Payment

3. Original Note Balance

4. Months / Years Financed

Interest Rate (%)

5. Monthly Payment

6. Balloon Payment?
YesNo

If Yes, Date

Balloon Amount

7. Date of First Payment

Current Appraised Value

8. Current Balance

9. Owner Occupied?
YesNo

10. Underlying Balance?
YesNo

If Yes, Amount

11. Credit of Payer
ExcellentGoodBadUnknown

12. Property Type
SFRDuplex/Four-plexCondo/TownhomeMobile Home - SingleMobile Home - DoubleCommercialLand OnlyLand with Improvements

13. Deed Type
Deed of TrustMortgageLand ContractContract for Deed

14. Title Policy?
YesNo

15. Property Description / Comments