Richness Business Note Buyer   
                         NOTE SUBMISSION WORKSHEET
                          P. O. Box 831, McHenry, IL 60051-0831
                        Office 866.572.5925      Fax 815.578.9030

PROPERTY INFORMATION:
Address: __________________________
City: ____________________________
State, Zip Code: __________________________________
Description Of Property: ______________
__________________________________
Current Value: ______________________
Date Of Sale: _______________________
Sales Price: _________________________
Down Payment: _____________________
1st Mortgage: _______________________
2nd Mortgage: _______________________
3rd Mortgage: _______________________
All-Inclusive (Wrap): _________________
LSC/CFD/Other: _____________________
NOTE INFORMATION:
Original Amount: ____________________
Original Term: ______________________
Interest Rate: ________________________
Payment Amount: ____________________
Monthly ____ Annually ____ Other______
Balloon Amount: _____________________
Date Of Balloon: _____________________
First Payment Due: ___________________
Number Of Payments Made: ____________
Number Of Payments Left: _____________
Current Balance: _____________________

PAYOR HISTORY:
Payments On Time: ___________________
Credit Worthiness Of Payor (A, B, C, D): _____
Owner Occupied Property (Y/N): ________
Personal Guarantee? (Y/N) _____________

DEFAULTED NOTES:
Liens: _____________________________
Back Taxes: ________________________
Occupied By Whom? _________________

BENEFICIARY/SELLER INFO:
How long has seller owned property? _____
____________________________________
Name Of Seller: ______________________
____________________________________
Married Or Single? ___________________
Address: ____________________________
City: _______________________________
State and Zip: ________________________
SS#: _______________________________
Phone #: ____________________________

COLLECTION INFORMATION:
Trustor/Buyer: _______________________
Address: ____________________________
City: _______________________________
State and Zip: ________________________
SS#: _______________________________
Phone #: ____________________________

Please use your browser to print this form. Click on File and then click on Print Preview (might need to scale down to fit on one page) then click Print.

Please print this form and fax this Worksheet, Copy of Note, Copy of Deed, Amortization Table of payments, and Last Copy of Title Insurance Policy to:  815-578-9030