Contact First Name:

Contact Last Name:

Contact Phone:

Are you personally recieving payments? Yes No ----

Note Category: $0 - $50K $50K - $200K $200K +

Type of Property: --Select-- SFR Multi-Unit Commercial Vacant Land Mobile Home Other

Payor's Credit: --Select-- A - 700 & Above B - 670 - 699 C- 630 - 669 D - 600 - 629 Unknown

Property Value:

City:

State:

Face Value of Note For Sale:

Note Balance:

Interest Rate:

Payment Amount:

Payments Made: --Select-- Monthly Quarterly Semi-Annually Yearly Other

Number of Payments Made:

Date of First Payment (--/--/----):

Number of Payments Remaining:

Next Payment Due Date (--/--/----):

Status: --Select-- Current Delinquent

Balloon Payment: --Select-- Yes No

Amount of Balloon Payment:

Due Date of Balloon Payment:

Email Address: