Integrity Home Buying, LLC

NOTE HOLDER'S QUOTE REQUEST
SUBMISSION FORM

Note Holders: Please fill in this form for a highly competitive CASH quote for your Note. We can pay up to 100% CASH for your Mortgage Note, Trust Deed or Real Estate Contract. Also buying Annuities, Lotto Winnings, Cash Streams. Questions? Just call 804-677-4136 or Email. Upon your acceptance of our quote, we will be in touch with you for the necessary documentation regarding such things as copies of deed, payers credit history, payment history, purchase agreement, appraisal, insurance.

(*) Indicates a required field for us to be able to quote. Additional information may allow us to be more competitive so please fill in as much as possible. Notes must be seasoned at least 3 months.

First Name*
Last Name*
Mailing Address*
City*
State*
Zip*
Daytime Telephone*
Evening Telephone*
Fax
Email*
Original Loan Amount
Interest Rate %*
Payment Amount*
Payments Made*
Date First Payment Made*
Number of Payments Made
Number of Payments Remaining
Note Balance*
Next Payment Due Date*
Loan Status*	Current Delinquent
Balloon Payment?*	Yes No
How Much Balloon Payment
Date Balloon Payment Due (Required if Note contains a Balloon)
Position of Note*
1st Lien - Remaining Balance
2nd Lien - Remaining Balance
Type of Property*
Payor's Credit Rating*
Property Value
Owner Occupied?*	Yes No
Sales Date*
Sales Price*
Down Payment*
Loan to Value Ratio
State Property Located*
City Property Located*

NOTE: If you experience difficulties submitting this form, please print a copy of it and fax it to 804-741-6313 or mail it to: Integrity Home Buying, LLC P.O. Box 3986 Glen Allen, VA 23058

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