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Mobile Home Note
Your Information
Title
Mr.
Mrs.
Miss.
Ms.
Dr.
Other
First Name
Last Name
Email
Phone #
(include area code)
Are you personally receiving payments from this?
Yes
No
Note Balance
Your note will not be considered with web addresses or solicitations!
Comments
Note Information
Payors Credit
A - 700 and above
B - 670 to 700
C - 630 to 670
D - 600 to 630
Below 600
Unknown
Property Value
Owner Occupied
Yes
No
How much land is collateral
Is the property located in a park
Yes
No
Star (***) rating of park
Monthly Space Rent $
Mobile Home Lot size
Is the Mobile Home physically attached to the land?
Yes
No
If the home is connected to and comes with property, please click here and complete the Real Estate form.
Make of Mobile Home
Model of Mobile Home
Man. Year of Mobile Home
Structure of Mobile Home
Single Wide
Double Wide
Dimensions of Mobile Home (ft)
Square Footage of Mobile Home (sq ft)
Purchase Date of Mobile Home
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
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30
31
Purchase Price
Down Payment
State
Please Select a State
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Outside United States
City
Face Value of Note
Interest Rate
Note Balance
Payment Amount
Payments Made
Monthly
Quarterly
Semi Annually
Annually
Other
# of Payments Made
When 1st Payment was Made
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
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31
Payments Remaining
Next Payment Due Date
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
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15
16
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19
20
21
22
23
24
25
26
27
28
29
30
31
Loan to Value (%)
Payment Status
Current
Delinquent
Balloon Payment
Yes
No
Size of Balloon Payment
Date of Balloon Payment
January
February
March
April
May
June
July
August
September
October
November
December
01
02
03
04
05
06
07
08
09
10
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30
31
Position of Note
1st
2nd
3rd
other
1st Remaining Balance
2nd Remaining Balance
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