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SECTION A - Office use only
SECTION B - Homeowner and Property Information
Owner Name   Address  
City   Closest Major City
 
Distance from propertymiles
State   Zip  
Telephones Home                    Work                      Cell
         
                       
Type of property If Mobile Home, Make, Year, Size: Current Estimated value   
How many bedrooms?   How many baths?  
Describe any special features
Status of property
SECTION C - Debt on the Property Information
Type of Mortgage: Book & Page number:
Date Created:    Beginning Amount:  
Terms: (other, explain):
Interest rate: %   Payment amount:   (not including taxes or insurance)
Balloon due date:  
# of payments in arrears:    Amount of late fees:   
Attorney fees:    Grand total due:   
SECTION D - Lender contact information
Name:   E-mail Address:  
Address:
City: State:
Zip:
Phone:    Fax: 
Is there a case number already assigned?If no, explain
SECTION E - Property Sale Information
Sale Date    (Explain if not same date mortgage created)
A. Sales price    D. Amount of 1st mortgage   
B. Cash down payment    E. Amount of 2nd mortgage   
C. Amount Financed    F. Total Debt on property   
C and F must be the same amount. For example, if the house sold for $100,000 (A) and there was a down payment of $20,000 (B), then total being financed would be $80,000 (C). If the first mortgage is $50,000 (D) and the second mortgage is $30,000 (E), then the total debt is $80,000 (F). If C and F are not the same, explain why:
SECTION F - First Mortgage, if SECTION C describes a Second Mortgage
Type of Mortgage: Book & Page number:
Date Created:   Beginning Amount:  
Terms: (other, explain):
Interest rate: %   Payment amount:  (not including taxes or insurance)
Balloon due date:   1st pmt made date:  
Are payments Interest Only? (If no, mortgage has a payoff period of years) 
SECTION G
What is the maximum payment you can make, and other financial details to support out negotations?
 
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