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Purchase Quote Questionnaire
Please fill in this form so we can give you a cash quote:
Retail Face Value to Sell
$
Category
Please select
Secured Note
Unsecured Note
Trust Deed
Bad Debt
Lease Agreement
Vehicle Loan
Estate Property
Beneficial Interest
Annuity
Delayed Payments
Viatical
Judgement
Collection
Receivables
Payables
Inventory
Equipment
Partnership
Stock
Business
Patents
Royalties
Collectables
Coins
Jewelry
Other
Note Balance
$
Interest Rate
%
Payment Amount
$
Payments Made
Please select
Monthly
Quarterly
Semi Annually
Annually
Other
When 1st Payment Made
# of Payments Made
# of Payments Remaining
Next Payment Due Date
Current or
Delinquent
Balloon Payment
Yes
No
Balloon Amount
$
When Balloon Due
Position of Note
Please select
1st
2nd
3rd
Other
1st - Remaining Balance
$
2nd - Remaining Balance
$
Type of Property
Please select
SFR
Multi-Unit
Commercial
Vacant Land
Mobile Home
Owner Occupied
Rental
Other
Brief description of property:
Payor's Credit
Please select
A - 700 & above
B - 670
C - 630
D - 600
Unknown
Property Value
$
Owner Occupied?
Yes
No
Sales Date
Sales Price
$
Down Payment
$
Loan to Value
%
State
Please select a state
Outside United States
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
City Location
Contact First Name
Last Name
Referred by
Please select
Note Holder
Note Broker
Real Estate Broker
Financial Planner
Accountant
Attorney
Mortgage Broker
Bank Officer
Internet
Advertising
Web SEARCH
Client
Friend
Other
Phone Numbers
Email
Comments:
If you have any problems with this form or emailing it, you may copy this information into your email and send to
info@apexca.com
or fax it to(714) 667-8234, or call me direct at(714) 901-5777
Thank you for your request
