NOTE BROKER WORKSHEET

TO: Wall Street Brokers, Inc. 500 Wall Street #405 Seattle WA 98121-1577

FROM:

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Name

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Company

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Street

_______________________________________________________

City State Zip

_______________________________________________________

Telephone / Fax

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E Mail / URL

SECURITY INFORMATION

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Street

_______________________________________________________

City State Zip

Single Family residence _____ Owner occupied ____ Rental: ____ Mobile: ____

Vacant Land:____ Acres: ____ Septic:____ Water: ____ Sewer _____ Electricity ____

Commercial: ____ Industrial ____ Multi-family: ____ No. of units: ____

BUSINESS: ____ Includes Real Estate? Yes: ____ No: ____

Describe real estate and improvements or business:

_______________________________________________________

_______________________________________________________

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Current fair market value: $________________________________

Based on: Realtor Opinion: ____ Appraisal: ____ Tax Assessor: ____

NOTE FOR SALE

Lien Position: 1^st: ____ 2^nd: ____ Wraparound: ____ Other: ____

Date property sold: _______________________________________

Down payment: $__________________________ paid in cash

Original Amount of Note: $________________________________

Date of Note: ___________________________________________

Current balance due: $____________________________________

Date interest is paid to: ___________________________________

Date next payment is due: __________________________________

Interest rate: ___________% per annum

Payment: $______________________ per month. If payments not paid monthly, explain:

_______________________________________________________

Balloon cash out due date: _________________________________

Additional information or terms:

_______________________________________________________

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WHERE IS THE ORIGINAL NOTE LOCATED? ___________________________

OTHER LIENS ON SAME PROPERTY

Other liens: 1^st ____ 2^nd ____ Other: ________________________

Conventional: ____ VA: ____ FHA: ____ Private: ____

Balance due: $__________________________ Payment: $________________ per month

Interest rate: ___________% per annum

Additional information: ____________________________________

________________________________________________________

PAYOR INFORMATION

If other, explain: ____________________________________________

Does payor make payments on time? Yes: ____ No: ____ Don’t know: ____

Who does the payor pay? Seller: ____ Servicing Agent: ____

Is payor employed? Yes: ____ No: ____ Don’t know: ____

Will payor cooperate? Yes: ____ No: ____ Don’t know: ____

Payor #1 Name: ______________________________________________

Payor #1 Social Security Number: ________________________________

Payor #2 Name: _______________________________________________

Payor #2 Social Security Number: _________________________________

Payor Address: ________________________________________________

Street

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City State Zip