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Current Street Address: Enter Address

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City: Enter City

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State & Zip Code Enter State & Zip Code

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Home Phone: Enter Phone Number

Cell Phone: Enter Phone Number

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Type of Property:

Home

Mobile Home

Commercial

Vacant Land

Is the Property Owner Occupied:

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Has the Property Been Renovated:

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Date First Payment Was Received:

Sale Price of Property: Enter Text

Amount Received for Down Payment: Enter Text

Current Balance Owed You: Enter Text

Current Interest Rate on Balance: Enter Text

Payment Amount: Enter Text

Is the Note Up To Date or Delinquent:

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If Delinquent - How Many Months Behind: Enter Text

Is There A Balloon Payment Due: Enter Text

If Yes - When is Balloon Payment Due: Enter Text

What Position Is The Lien In: Enter Text

What is The Borrowers Credit Score: Enter Text

Is There An Underlying Mortgage:

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Property Street Address: Enter Text

Property City, State, Zip: Enter Text

Do You Have More Notes Owed You Besides Above Address:

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5109 82nd Street • Suite 71135 • Lubbock, Texas • 806-748-1305