First Name:

Last Name:

Email Address:

Phone Number:

Best Time to Call:

Morning Afternoon Evening

Reason for selling Note:

Is the note current:

Yes No

If No, how far behind:

Credit Score of Payor:

Property Type:

Single Family Condo Duplex

Payment Frequency:

Monthly SemiAnnual Annual Interest Only

Property Street Address:

City or Town

State of Property:

Property Zip Code:

Date of Sale:

First Payment Date:

Original Home Sales Price:

Amount of Down Payment:

Original Note Amount:

Interest Rate of Note:

Payment Amount:

Length of Loan:

Balloon Payment:

Yes No

Due Date of Balloon:

Lien Position:

First Second Third

Additional Information:

Customer Note: Solidity has a strict policy not to release any information outside
of our organization. Everything submitted to us is retained under the strictest confidentiality.