A1securednotes

Please provide the information below to request your free note analysis online. You will find it helpful to have these documents handy while completing the information: Settlement Statement Mortgage (Deed of Trust, Real Estate Contract etc) Promissory Note, and Payment Record. If you have any questions or prefer to speak with someone directly, please feel free to contact us at 937-234-7409.

Your Name(Required)

First Last

Your Address

Street Address Address Line 2 City State ZIP Code

How Can We Reach You?

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Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

How Did You Hear About Us?

Property Information

Please tell us about the property you are receiving payments on.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Property(Required)

Year Property Built

Acreage

Property Description

Occupancy

Owner Occupied

Rental

Vacant

Current Estimated Value of Property

Note Information

Please provide information on the Mortgage Note, Trust Deed, or Real Estate Contract.

Sale Date/Date of Note

Property Sale Price

Down Payment Amount

Original Starting Balance of Note

Current Principal Balance of Note

Interest Rate

Payment Amount

Payment Schedule

Next Payment Due Date

Is There an "All Due" Or "Balloon Payment" Date?

Yes

Balloon Payment Date

Are Payments Current?

Yes - Current

No - Delinquent

If Payments Are Delinquent Please Describe Payment History

Who Collects Payments

Seller Collects Directly From Buyer/Payer

Third Party Servicer

If Third Party Collects Payments Please Provide the Company Name, Address, and Account Number

Is This A First Position Note?

Yes

If No, Please Provide Amount of First Mortgage

Who Makes Payments On The First Mortgage

Seller

Buyer/Payer

Additional Information

Buyer or Payer's Credit Score

Please enter a number from 300 to 850.

Please Let Us Know Any Special Circumstances or Reasons for Selling the Note

Copies of Documents

Max. file size: 32 MB.

It is helpful to have copies of the transaction documents to provide a more accurate note analysis. You can upload copies from your computer or fax to our office.

Are You Providing Copies of Documents At This Time?

Yes - By Fax

Yes - Copies Included in Attached Upload

No - Documents Will Follow At A Later Date

Additional Comments

Are You Ready to Send This Online Form?*(Required)

Yes

When you are ready to send the information please select “Yes” and then click on the Submit Button below.

Comments

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Note Submission Worksheet

How much is my note worth?

How Can We Reach You?

Property Information

Note Information

Additional Information