Note Funding Application

OWNER INFORMATION:

Owner Name:
Business Name:
Street Address:
City:
State:	Zip:
Phone:	-- Ext. Fax: --
E-mail:	Website:

PROPERTY INFORMATION:

Property is a

	Business
	Home

Description of Location:
City:
State:	Zip:

Complete the following if property is a business:

Name of Business	Lease Expiration:
Terms of Lease Renewal:

Briefly describe the qualifications the payor has to operate this business:

If the Payor is a corporation, is there also a creditworthy individual liable for payments?

Yes No

How Long has business been at this location?

Is the Operation a Franchise? Yes No

If Yes, has the franchiser committed to cooperate with the note buyer in event of foreclosure or resale? Yes No

Complete the following if property is a home::

Estimated Value: $ Basis for Estimate:

Type of Property?

	Residential, Single Family
	Residential, Multi-Family
	Commercial
	Vacant Land

The Property is a

	Owner-Occupied
	Rental

HISTORICAL INFORMATION:

Date of Sale: Selling Price $ Down Payment $

First Lien $ Second Lien $

NOTE INFORMATION:

Date of Note: Amount of Note $

Term of Note (in months):

Payment Amount (Monthly) $ Balloon Payment Amount $

Balloon Payment Date: Interest Rate: %

First Payment Due Date:

Number of Payments Paid: Number of Payments Remaining:

Next Payment Due Date: Balance $

PAYOR INFORMATION:

Name: SSN #: Employer:

Briefly Describe Payment History:

MISCELLANEOUS::

Briefly Describe why you would like to sell the note:

How did you find us?

	Search Engine
	Print Ad
	Referral
	Otherr

Thank you for your interest in DGN Funding. A DGN consultant will get back to you within 24 hours of receipt of this application.

Questions about this application? Call: 1-877-865-7906 or Email: inquiries@dgnfunding.com