Online Note Worksheet

Ready to discover your options?

Please provide the information below to request your free note analysis online.

You will find it helpful to have these documents handy while completing the information:

Settlement Statement
Mortgage (Deed of Trust, Real Estate Contract etc)
Promissory Note, and
Payment Record

If you have any questions or prefer to speak with someone directly, please feel free to contact us at 607-316-3411.

Online Note Worksheet

Name
First Last
Email*
Phone Number
Your Mailing Address
Street Address City State ZIP Code
How Did You Hear About Us?
Property Information
Please tell us about the property you are receiving payments on.
Property Address
Street Address City State ZIP Code
Type of Property*
Year Property Built
Acreage
Property Description
Occupancy
- Owner Occupied
- Rental
- Vacant
Current Estimated Value of Property
Note Information
Please provide information on the Mortgage Note, Trust Deed, or Real Estate Contract.
Sale Date/Date of Note
Month
Day
Year
Property Sale Price
Down Payment Amount
Original Starting Balance of Note
Current Principal Balance of Note
Interest Rate
Payment Amount
Payment Schedule
Next Payment Due Date
Month
Day
Year
Is There an "All Due" Or "Balloon Payment" Date?
- Yes
- No
Balloon Payment Date
Are Payments Current?
- Yes – Current
- No – Delinquent
If Payments Are Delinquent Please Describe Payment History
Who Collects Payments
- Seller Collects Directly From Buyer/Payer
- Third Party Servicer
If Third Party Collects Payments Please Provide the Company Name, Address, and Account Number
Is This A First Position Note?
- Yes
- No
If No, Please Provide Amount of First Mortgage
Who Makes Payments On The First Mortgage
- Seller
- Buyer/Payer
Additional Information
Buyer or Payer's Credit Score
Please Let Us Know Any Special Circumstances or Reasons for Selling the Note
Copies of Documents
Max. file size: 300 MB.
It is helpful to have copies of the transaction documents to provide a more accurate note analysis. You can upload copies from your computer or fax to our office.
Are You Providing Copies of Documents At This Time?
- Yes – By Fax
- Yes – Copies Included in Attached Upload
- No – Documents Will Follow At A Later Date
Additional Comments
Are You Ready to Send This Online Form?*
- Yes
- No
When you are ready to send the information please select “Yes” and then click on the Submit Button below.
Email
This field is for validation purposes and should be left unchanged.

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Pure Synergy Investments
Mountain Rest, SC
607-316-3411

Online Note Worksheet

Property Information

Note Information

Additional Information

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