American Equities, Inc.

Sellers QUOTE REQUEST FORM

Date:*
First Name:*
Last Name:*
Phone:*
Email:*
Address of Property:*
Description of Property:*
Any Other Details
About Property:*
Instrument Used:*
Position:*
Collection Method:*
If Service Agency
Name of Agency:*
Date Sold:*
Sale Price:*
Estimated Current
Property Value (if known):*
Down Payment:*
Interest Rate:*
Current Balance:*
Monthly Payment:*
Number of
Payments Remaining:*
Balloon Due Date:*
Underlying Balance:*
Person Submitting Request:* Note Holder
Broker
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Comments:
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