GENERAL INFORMATION
What would you like this appraisal to be known as?

I AM THE :
Note Holder
Real Estate Broker
Attorney
Accountant/CPA
Mortgage Broker
Bank Officer
Note Broker
Other
Financial Advisor

YOUR DATA
* Your Name (Not your client’s name):
Your Company Name:
* Your Address:
* Your City:
* Your State:
* Your Zip:
* Your Phone #:
Your Fax #:
Your E-Mail Address:

YOUR CLIENT'S DATA
Your Client’s Name:
Your Client’s Company:
Your Client’s Address:
Your Client’s City:
Your Client’s State:
Your Client’s Zip:
Your Client’s Phone #:
Your Client’s Fax #:
Your Client’s E-mail Address:

CLOSING INFORMATION

Creator of Note (Name):
Attorney Name:
Address:
City:
State:
Zip:
Phone #:
Fax #:

Escrow Company Name:
Escrow #:
Address:
City:
Phone #:
Fax #:

Title Insurance Company:
Title Agent Name:
Address:
City:
State:
Zip:
Phone #:
Fax #:

If Note Assigned
Assignee Name:
Address:
City:
State:
Zip
Phone #:
Fax #:

NOTE PAYER INFORMATION
*Payer’s Name:
*Current Address:
*City:
*State:
*Zip:
*Payer’s Phone:
Payer’s Fax:
Payer’s E-mail:

Payer’s Prior Address: (if at current address less than 5 years)
City:
State
Zip
Payer’s Social Security #:
Payer’s Fico Score:

CO-Payer’s Name:
Current Address:
City:
State:
Zip:
CO-Payer’s Phone #:
CO-Payer’s Fax #:
CO-Payer’s E-mail:

CO-Payer’s Prior Address: (if at current address less than 5 years)
CO-Payer’s Social Security #:
CO-Payer’s Fico Score:

PROPERTY INFORMATION

Property Address:
Unit #:
City:
State:
Zip:
County:

Current Value: $

How was the value determined?
Appraisal
Tax Assessment
Realtor Opinion
Other

If Appraisal, Date of Appraisal:

COLLATERAL TYPE
Please choose either Residential, Commercial, or Land

Residential:
Single Family Residence
Condo/Townhouse
Mobile Home (Singlewide) with Land
Mobile Home (Doublewide) with Land
Mobile Home Without Land

If Mobile Home, what year was it manufactured?

Description of Neighborhood

Is Property Owner Occupied or Rental?
Owner Occupied
Rental

If Rented: Amount of Rental Income $

Property Size: Lot Size or # of Acres

COMMERCIAL

Description of Business or # of Apartments

Amount of Lease or Rental Income #

Property Size: Lot Size: or # of Acres:

LAND

Description:
Unimproved Land
Buildable Lot
Improved Land
Farm Land
Commercial Land
Timber Land

Property Size: Lot Size: or # of Acres:

INSURANCE

Insurance Agent/Company:
Policy #
Agent/Company Phone #:
Expiration Date:
Loss Payee:

NOTE INFORMATION
Note:
New Note
Existing Note (over 6 months):

Date of Property Sale:
Property Sales Price:
Cash Down:
Note Amount Financed 1st Position: $
Note Amount Financed 2nd Position: $
Note Amount Financed Total: $
Are There Any Liens on Property? Yes No
If Yes, $ Amount of Liens:
Current 1st Position Note Balance: $
Current 2nd Position Note Balance: $
Current 3rd Position Note Balance: $
Current 4th Position Note Balance: $
Current Offer Note Balance: $
Current Total Debt/Loan Balance on Secured Property: $
Current Value of Secured Property: $
Total Loan to Value %: (Total Loans Divided by Property Value)
This Note Loan to Value %: (This Note Balance Divided by Property Value)
Original Note Balance:
Months Amortized:
Interest Rate:
Payment Amount: $
Payments Made:
Monthly
Quarterly
Semi Annual
Annual

First Payment Due Date:
Final Payment Date:
# Payments Made:
# Payments Remaining:
Next Payment Due Date:

Payment Status: Current Delinquent

If Applicable, :
Balloon Amount:
Balloon Due Date:

Adjustable Rate Terms:
Adjustable Rate Cap:
Scheduled Payment:
Additional Principal Payments Made? $

Other Information:

I have the following, and can make copies available by:
E-mail Fax Mail

Original Real Estate Note Yes No
Closing Statement Yes No
Recent Appraisal Yes No
Proof of Insurance Yes No
Recent Photo of Property Yes No
Payer’s Credit Report Yes No

Comments or Added Details About Note