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Contact Information
Your Name:

Type of Property (check all that apply)
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Single Family Residence -- Owner Occupied:
Multi-Family -- Number of Units:
Commercial/Industrial Building
Mobile Home -- Year:
Land -- Acreage:
What utilities are available in the street or on the property?

Property Information
Street Address:  
City, State, Zip:  
Or Parcel Number:  
Brief Description of the Property (# of bedrooms/baths, etc.):

Note Information
Position: 1st    2nd  
Date Property Sold:  
Sales Price:  
Cash Down:  
Current Balance:  
Interest Rate:  
Monthly Payment (P&I):  
Next Payment is due on:  
Balloon Date if any:  
Non-monthly Payment (If applicable/-please explain):