MORTGAGE NOTE QUOTE REQUEST FORM

Please fill out the following form in its entirety and as accurately as possible to ensure the highest quote. If you prefer you can simply download the form in PDF format and fax it back to us at 888-755-8521.
It is First Capital Funding Corporation's policy that the broker must be working directly with the
note seller to obtain bid. No quotes from notes posted on web sites or from multi-brokers.

IF THIS IS A SIMULTANEOUS CLOSING PROPOSAL (THE NOTE HAS NOT YET BEEN CREATED) PLEASE CLICK THIS LINK TO COMPLETE THE SIMULTANEOUS CLOSING FORM INSTEAD

Your Information
The person completing this form is:
First Name:
Last Name:
Address Street:
Address Street 2 as needed:
City:
Zip Code:	(5 digits)
State:
Your Contact Information
Daytime Phone:
Evening Phone:
Cell Number:
Fax Number:
Email:
Note Information
Property Sales Date:
Sales Price
Down Payment Made
Original amount of the Note:
Current Balance
Term in Months
When was the first payment made on this note?
Next payment due date:
Number of payments made:
Number of payments remaining?
Principal and Interest Payment Amount:
Interest Rate:	%
Lien Position:
If Wrap or AITD indicate amount of senior lien:
Instrument Type	Mortgage, TD or land contract
Is there a Balloon?
If yes, what is the Balloon payment amount:
Balloon payment date:
Are the note payments delinquent or current:
Property Estimated Value:
Based on:
Payor's credit rating if known?
If there is a 2nd Note what is the Remaining Balance?
Property Information
Location State:
Location City:
Location County
Property Type:
Owner Occupied?:
Marketing Information
Please Tell us how you found us:
If via a search engine, can you tell us what keywords you used?