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1 .
First Name *
2 .
Last Name *
3 .
Email Address *
4 .
Telephone Number
5 .
Are you personally receiving payments on this note? *
Yes No
6 .
What was the date of sale? *
7 .
What was the purchase price (in $)? *
8 .
What was the down payment amount (in dollars)? *
9 .
What was the original face value of the note? *
10 .
What was the original term of the note? Please indicate months or years *
11 .
What is the interest rate on the note (in percentage)? *
12 .
What is the monthly payment amount? *
13 .
What is the note balance? *
14 .
When was the first payment made on your note? *
15 .
How many payments have been made? *
16 .
How many payments remain? *
17 .
Is the note: *
Current
Delinquent
18 .
Have all the payments been made on time? *
Yes No
19 .
If no, please elaborate. How many late payments? How late have they been? Is the note current now?
20 .
What is the payor's credit rating? *
21 .
Is dealer resource available? *
Yes No
22 .
Please describe the automobile. Include make, model, year, options. *
23 .
Please tell us about your needs and expectations so that we may better serve you. *
24 .
How many payments would you like to sell? *
25 .
How much money would you like to get by selling these payments? *
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