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First Name

Last Name

Phone

Email Address

Original Loan Amount

Property Sold Price

Down Payment Amount

1st Payment Date

Interest Rate

Monthly Payment Amount

Balloon Date (if any)

Length of Loan (month or years)

Name of Buyer making payments to you

Property Address, City, State, Zip Code

County the Property is located in

Buyer's home address (if different)

Payments Current (yes / no) YesNo

Do you still owe money on this property as well? YesNo

If yes, approximate amount you currently owe?

Anything else you would like to share with us?