Note Holder Name

Note Holder Company

Date

Note Holder Street Address

Note Holder City

Note Holder State

Note Holder ZIP Code

Note Holder Phone Number

Note Holder Email Address

Property Street Address

Property County

Property City

Property State

Property ZIP Code

Current Estimated Value ($)

Type of Note Type of NoteSingle-Family MetropolitanSingle-Family RuralTownhouseCondominiumSingle-Family with AcreageManufactured HomeLot / Land2-4 Unit Multi-FamilyApartment ComplexMixed UseMobile Home with Lot / Land

Current Status Current StatusPerformingNon-PerformingSub-Performing

Current Occupancy Current OccupancyOwner-occupiedRentalVacant

Description of Property / Surrounding Area

Seller Motivation

Date of the Note

Amount ($)

Terms (in months)

Payment Amount ($)

Interest Only Payments? Interest Only Payments?YesNo

Balloon Amount ($)

Balloon Date

Interest Rate (%)

1st Payment Due-Date

Original Number of Payments

Number of Payments Made

Next Payment Due-Date

Number of Payments Left

Balance Left

Payment Frequency Payment FrequencyBi-WeeklyMonthlyQuarterlySemi-AnnuallyAnnuallyOne-Time Balloon

Sale Price ($)

Prior Mortgage Date of Sale

1st Lien Position (Name)

Down Payment Amount ($)

Borrower Name

2nd Lien Position (Name)

Borrower Street Address

Type of Borrower Type of BorrowerIndividualCorporate EntityGovernment EntityTrustOther (state below)

Borrower County

Borrower City

Borrower State

Borrower ZIP Code

Borrower Employment Status Borrower Employment StatusEmployed ($1 - $50k/yr)Employed ($50k - $100k/yr)Employed ($100k+/yr)Un-employed

Borrower Credit Score

Any Additional Information