Mortgage Submission Worksheet

Please provide as much of the applicable information as
you can for a free no-obligation quote. 

Your Information
Your Name
 Phone
 Fax
E-Mail Address -- important!

Seller Information,
Note Seller Name
Address
Home Phone
 Work Phone
  Fax

Property and Lien Type (multiple selections allowed)
Property Location
 
First Lien, Mortgage, Trust Deed Owner Occupied Non-owner Occupied
2nd Lien, Mortgage, Trust Deed Single Family Multi-Family
Contract-for Deed Duplex Commercial Income
Wrap Lien Triplex/Fourplex Land (only)
Direct (Non-purchase money) Mobile Home (affixed) Farm or Ranch
Other: Rural Urban/Suburban
If property is a mobile home affixed to land
Year

Doublewide? 
(Yes or no)

Dimensions
Value
Current Appraised/Estimated Value
$: 		How Was This Obtained? (i.e., appraisal, realtor, etc.)

Sales Information
Sales Price $: 

Sales Date (mm/dd/yy):

Cash Down Payment $ 
 First Mortgage $
 Second Mortgage $

Terms of Note For Sale
Date of Origination 
 Face Amount $
 Term (months) 
Payment $ 

 Balloon Term (months) Current Balance $
Original Loan-to-value ratio Current Loan-to-value ratio
Interest Rate 
 Balloon Amt $ (if any) First Payment Due Date
Next Payment Due Date 

 # Payments Made
 # Payments Remaining
Are Payments Current
Within Last 12 Months?
YES- NO- 		Any Known
Credit Problems?
YES- NO- 		If so, please explain

Terms of Underlying Note (if one exists)
Date of Origination 
 Face Amount $
 Term (months)
Balloon Term 
 Current Balance $
 Interest Rate
Payment Amount $
 Balloon Amount $
 First Payment Due Date
Next Payment Due Date
 # Payments Made
 # Payments Remaining
Name of payor

Comments:

Please contact me as soon as possible regarding this matter.

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