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Your
Name:*
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Your
Company:
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Address:
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City,
State, Zip:
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,
,
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Home
Phone:
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Work
Phone:*
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ext:
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E-mail
Address:*
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Please
contact me by:*
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email,
home phone,
work phone
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| Best
time to reach me: |
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Property
Information
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| Approx. Property
Value:* |
$
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| Property
Purchase Price: |
$
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| Property
Purchase Date: |
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| Any
foreclosures, bankruptcies, leins, or judgements?* |
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| Property
Type:* |
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Property
Description: |
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Property
Address:*
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Property
City & State:*
|
,
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| Does
Your Client Own Any Other Real Estate?* |
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Existing
First Trust Deed
|
|
Present
Balance:*
|
$
(if none type "0")
|
|
Original
Balance:
|
$
|
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Monthly
Payment:
|
$
,
current or past due:
|
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Interest
Rate:
|
, Term:
|
|
Existing
Second Trust Deed
|
|
Present
Balance:
|
$
|
|
Original
Balance:
|
$
|
|
Monthly
Payment:
|
$
,
current or past due:
|
|
Interest
Rate:
|
, Term:
|
|
Loan
Quote Request
|
| Requested
Loan Type:* |
|
| Amount
of Loan Requested:* |
$
|
| Purpose
of Loan: |
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| Referral
Fee Requested: |
$
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| Amount
of Cash Down Payment (if purchase): |
$
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| Amount
of Seller Carryback (if applicable): |
$
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|
Term
Desired:*
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Comments/other
issues: |
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