Enter today's date: -- mm/dd/yy

How did you hear about Westshore?  Radio Television Newspaper Mail Referral Other

Please specify source: 

Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
FAX
E-mail
URL

Subject property address (street address, city, state & zip code).

Property Type:     Residential (single family) Multifamily (two, three or four family) Mobile home with land Vacant land (no improvements) Improved land (well, septic, utilities, road, etc) Commercial Industrial

Occupancy:  Owner Occupied Non Owner Occupied

Subject lien position:  First Second Third Wrap Around Mortgage Contract/Agreement for Deed or Land Contract

Square footage of building: 

How many bedrooms?     How many bathrooms?

Other pertinent property information:

The property sale was closed by a:  Title Company Attorney Other

I have a copy of:   

     A Lender's Title Insurance Policy (insuring you as seller or lender)
     A recent property appraisal

Appraised value: $

If no appraisal, current estimated value: $

Date of sale:-- mm/dd/yy

Sale Price: $

Down Payment: $

Land Contract Amount: $

Terms of Land Contract - Number of months:

Interest Rate: %

Interest Rate is:  Fixed Adjustable

If adjustable rate, what is the floor rate: %   and the margin:  %

Land Contract payment amount: $

Land Contract balloon amount: $   Balloon Date:-- mm/dd/yy

Due date of first payment:-- mm/dd/yy

Number of payments made to date:

Number of payments remaining:

Date next payment is due -- mm/dd/yy

Current Land Contract balance due: $

Underlying mortgage balance: $  (if subject mortgage is a second, wrap or land contract)

The cash from the sale is needed for what purpose?: 

Would you like a quote to sell:  All of the remaining payments Part of the remaining payments Both

In some cases we may only elect to buy "part of the remaining payments," Please indicate amount needed  for your situation: $  (e.g., 50,000)  (we will need to figure how many payments to  buy in order to get this amount)

Please rate the buyer's credit: "A" Credit or Excellent "B" Credit or Good "C" Credit or Fair "D" Credit or Poor Unknown

Are the payments current? Yes No  

Do you have conclusive proof of payment history such as bank deposit receipts or bank statements?  Yes No

Are you in possession of the Original Recorded Documents? Yes No

Please rate your level of interest in selling the subject Mortgage:  

Very Interested Would like to sell now Somewhat Interested May Sell Soon Just Curious

Please add any pertinent information that you may want to have considered and/or any additional features of the property (acreage, improvements, additions, etc.):