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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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"Funding Your Future Today!"
Great North American Capital
319 Old Stratfield Road
Fairfield, CT 06825
203-520-4561
203-345-3943 Fax

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