Secure Mortgage Note Submission Form
Donald Jeffery & Co., LLC
Your Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Original Selling Price
*
Down Payment
*
Original Note Balance
*
Months / Years Financed
*
Interest Rate
*
Monthly Payments
*
Balloon Yes or No? If Yes, Date:
*
Date of First Payment
*
Current Balance
*
Owner Occupied
*
Yes
No
Credit of Payer
*
Excellent
Good
Bad
Unknown
Property Type
*
Single Family Res.
Duplex / Four-plex
Condo / Townhouse
Mobile Home
Land
Land with Improvements
Commercial Property
Is this property owned free and clear ?
Yes
No
Are there any other liens on this property that you are aware of ?
Yes
No
Property Address / Comments
*
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