Quote Request

Mortgage Note Quote Request Submission Form


Please complete the quote request form below in order for us to provide you with an accurate quote. The more accurate the information you provide us, the more accurate the quote. If you are unsure of some of the information required, call us. We’ll take your quote request right over the phone, 7 days a week.


For Business Notes Please Call

Full Name



Property Sale Date

Date of 1st Payment

Property Address

City, State ZIP

Purchase Price

Down Payment

Original Note Amount

Current Est. Property Value

No. Years Amortized

Interest Rate

Payment Amount

No. Payments Remaining

Balloon Date if Applicable

Balloon Amount if Applicable

Current Balance

Have Payments Been on Time?

Owner Occupied

Type of Property
 Single Family Residence (Not a Mobile Home) Mobile Home with Permanent Foundation Multi Family Commercial (No Corp., LLCs, etc unless personally guaranteed) Land

Estimated Borrower Middle Credit Score
 500 to 599 600 to 699 700+ Unknown

Are You a Broker or Seller
 Broker Noteholder/Seller

Additional Comments