MORTGAGE/TD INTAKE SHEET TO: ____________________________________________ FAX (____)________________________ BROKER'S NAME: ____________________________ COMPANY ______________________ BROKER'S FAX (____)__________________________ PHONE(____)_____________________ Tell Us About The Property What is the address of the property securing the note? ________________________________________ Does the note payor live there? _____ (If not) Is it currently rented? _____ For how much? $_______ What kind of property is it? (i.e., single family home, condo, duplex, apt. bldg., lot /land, etc.)______________ Describe the property & neighborhood in detail __________________________ _____________________________________________________________________________________ What was the sale price of the property? $_________________ What was the sale date? ____________ How much cash did the buyer put down? $__________ How much was the 1st mortgage? $_________ If there is a current appraisal on the property how much did it appraise for? $________ When was it done?_____ If there is no current appraisal, how much is the property worth today? $______________ Tell Us About The Mortgage (Trust Deed or Contract) Is the mortgage you want to sell a 1st mortgage? Yes ___ No ___ (If Yes, skip the next 4 lines) What is the name of the lender holding the 1st mortgage? ________________________________ Is it a (check one) FHA mortgage ___ VA___ Conventional ___ Private ___ What is the original amount of the 1st mortgage? $__________ Current balance? $____________ Interest rate ? ___% Monthly payment ? $__________ Does this include taxes & insurance?____ What was the original balance of the mortgage you want to sell? $_______ Current balance? $_______ How long is the mortgage originally written for?__________ What interest rate? ____% How much are the payments? $________ per ____ Are they current?___ If not, how far behind? ____ What was the date of the first payment? __________ When is the next payment due? _______ How many payments have been made? _____ How many remain? ____ If a balloon payment will be due, how much is it? $___________ What is the date the balloon is due? ________ Tell Us About The Payor How often have they been late? ____What is the payor's employment? __________________________ What is their name(s), address and (if known) S.S. No.? ______________________________________ Tell Us About Yourself Why do you want to sell the note? ________________________________________________________ How much cash do you need right now? $______________ What else should we know about the note, the payor, the property or any other aspect of this? _____________________________________________________________________________________What do you think is a fair price for your mortgage? _____________ SELLER'S NAME: _________________________________________________________ (Put seller's address and phone on the back, not to be faxed to investor unless requested) ADDITIONAL INFORMATION OF USE TO INVESTOR: Please Print - fill-out the form and Fax to: 219-886-2237 Or Mail to: Mpnnotes P.O. Box 561, Gary Indiana 46402 USA.