Quote Request Form - Land Note, Improved/Unimproved

Your Name :    

Address :        

City :                              State/Prov :           

Country :                         Zip/Post. code  :       

Phone no:                              Email :              

Property Information

Prop. Type:                           Current zoning :   

Address :        

City :                                State/Prov :          

Country :                            Zip/Post. code  :      

Prop. best use                     Desc. improvements:

Selling Price :                    Down Payment  :       

1st Mortgage:                   2nd Mortgage :         

Owner Occupied:    YesNo    Title Policy :  YesNo       Appraised Val   :   

Note Information

Type :                 Mortgage NoteDeed of TrustLand ContractContract for Deed                   Orig. Balance :              

Mortgage date:                  Term (Months/Years) : 

Mnthly pymt :                     Interest Rate:                 

Balloon amt:                       Balloon date :                  

Date 1st pymt :                  # pymts made :                

# Rem. pymts :                   Next pymt. due :              

Curr. balance :      Type of purch. you are interested :  Full PurchasePartial Purchase

Special Clauses                 Reasons for selling :

 Payor Information

Payor name :                Address : 

Payor Credit :    Please SelectA - ExcellentB - GoodC - Below AverageD - Poor

Documents Available

Could you provide copies of the following documents upon request ?

Note, Deed of Trust /Contract   NoYes   Escrow Closing Statement  NoYes   Title Insurance   NoYes

Current Hazard Insurance           NoYes               Payment Records     NoYes  Curr. pic/apprsl   NoYes

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