*Name:

Daytime Phone #:      Evening Phone #: (please provide at least one)

*When is the best time to contact you?

Mailing Address:

City:     State:     Zip Code:

Email Address:

*Property Type: (single family, duplex, mobile home, commercial, land, farm, etc.)

Property Address:

City:     State:     Zip Code:

Date of Sale:     *Sales Price: $    

*Down Payment: $    Original Note Amount: $    

*Current Balance: $    First Payment Date:     

Original Term:     # of Payments Made:     

*Principal & Interest Payment: $ *Interest Rate: %

*Lien Position: (1st, 2nd, 3rd) *Balloon Date: (n/a if there is no balloon)

*Property Occupied by Borrower:     Next Payment Due Date:

Current Estimated Value of Property: $    

Other Information: (Please provide any additional information that would assist us in providing you an accurate quote, such as whether the interest rate is adjustable, whether future payment amounts may change, the acreage on land loans or lots that exceed 5 acres, the type of business for commercial loans, etc.)

*Items with an asterisk are required.

THANK YOU for taking the time to fill out this questionnaire.  A representative from Freedom Financial LLC will be contacting you shortly to provide you your FREE, NO OBLIGATION quote.