Mobile Home Notes DELMarVA Judgment Services

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Mobile Home Note Worksheet
*Bold fields are required*
*Name:*
*Work#:*
Fax#:
Cell#:
*Home#:*
*Best time to call:*
*How did you hear of us:?*

*Email:*
*Face Value of Note:$*
*Note Balance:$*
*Interest Rate:%*
*Payment amount:$*
*Payments made:*
*Number of Payments made:*
*Number of Payments remaining:*
*Next payment due date:*
*Payment status:*
*Balloon payment:*
*Balloon payment:$*
*When Balloon payment due:*
*Position of note:*
*First remaining balance:$*
*Second remaining balance:$*
*Type of property:*
*Payor's Credit:*
*Property Value:$*
*Owner occupied:*
*Year of Mobile:*
*Size of mobile home:*
*How much land is part of the collateral:?*
*Sale date:*
*Down payment:$*
*Loan to Value:%*
*State:*
*City location:*
*Why do you want to sell:?*
*How much immediate cash do you need:?*
Do you have copies of these documents? (Check all that apply)
Note:
Security Instrument:
Title:
Sales Contract:
Payor Credit Report:
Closing Statement:
Bill of Sale:
Insurance:
The data, which we collect from you is not an application for credit. The intent of this form is for us to determine if a relationship between DELMarVA Judgment Services and/or its assigns and you and/or your company would be mutually beneficial. By submitting the required form, you authorize DELMarVA Judgment Services and/or its assigns to access any credit reporting agencies for which we are a member in your security interest under any agreements and transactions relating to DELMarVA Judgment Services and you and/or your firm. Your information is held in the strictest confidence and is used to help you achieve your goals in an expeditious and professional manner. ______________________________________________