Mortgage Note Submission Worksheet

Client Information

Street Address

City    State    Zip

Phone  Fax Email

Real Estate Information

Street Address

City    State    Zip

Current Estimated Value    Based On

Residential      Single Family     Mult- Family   
                          Owner Occupied    Rental

Commercial       Description
                       Owner Occupied      Rental

Vacant Land     Description

Description of Real estate Property and Area

Historical Information                                                    Prior Mortgage Information (if any)

Date of Sale                                
Selling Price                                 
Down Payment                             
First Lien                                     
Second lien                                  

Note Information                                                                                                                                        

Date of Note                              
Amount                                      
Term in Months                          
Payment Amount                   
Balloon Amount                           
Balloon Date                               
Interest Rate                             
Due Date 1st PMT                      
# of pmts paid                           
# of pmts left                               
Next pmt due                             
Balance                                      
                                                                          
                                                                                      

Payor Information                                                                      

Employment Info.

Payment History

Social Security Number

I have Copies of the Following:

Note                                    Yes    No

Security Instrument                Yes    No

Title                                    Yes    No

Sales Contract                      Yes    No 

Payor credit report                 Yes    No  

Closing Statement                 Yes    No

Bill of sale                            Yes    No

Insurance                             Yes    No

Prior Mortgage Info.                Yes    No