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Mortgage Submission Worksheet

Please provide as much of the applicable information
as you can for a free no-obligation quote. Please print out this form and

Fax to us at  (203) 345-3943

 

Your Information

Your Name
Phone
Fax
E-Mail Address -- important!

Seller Information,

Seller Name
Address
Home Phone
Work Phone

Property and Lien Type (multiple selections allowed)

Property Location
First Lien, Mortgage, Trust Deed Owner Occupied Non-owner Occupied
2nd Lien, Mortgage, Trust Deed Single Family Multi-Family
Contract-for Deed Duplex Commercial Income
Wrap Lien Triplex/Fourplex Land (only)
Direct (Non-purchase money) Mobile Home, affixed Farm or Ranch
Other: Rural City
If property is a mobile home affixed to land
Year
Doublewide? Yes or no.
Dimensions
Value
Current Appraised/Estimated Value
$:
How Was This Obtained? -- appraisal, realtor, etc?

Sales Information

Sales Price $:

Date

Cash Down Payment $

First Mortgage $

Second Mortgage $

Terms of Note For Sale

Date of Origination

Face Amount $

Term (months)

Payment $

Balloon Term

Current Balance $

Original Loan-to-value ratio
Current Loan-to-value ratio
Interest Rate

Balloon Amt $ (if any)

First Payment Due Date

Next Payment Due Date

# Payments Made

# Payments Remaining

Are Payments Current
Within Last 12 Months?
YES- NO-
Any Known
Credit Problems?
YES- NO-
If so, please explain

Terms of Underlying Note (if one exists)

Date of Origination
Face Amount $
Term (months)
Balloon Term
Current Balance $
Interest Rate
Original Loan-to-value ratio
Current Loan-to-value ratio
Payment Amount $
Balloon Amount $
First Payment Due Date
Next Payment Due Date
# Payments Made
# Payments Remaining
Name of noteholder

Comments:


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Great North American Capital
319 Old Stratfield Road
Fairfield, CT 06825

203-520-4561
203-345-3943 Fax


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