IMPERIAL PROCESSING

General information

Step 1/3

Property Owner's Name

Subject property address

City, State & Zip

Type of Property (commercial, residential, vacant land)

Is property owner occupied?

Very Important: Provide any additional known addresses for the borrower/ current owner (other than the above):

Other Known address (1)

Step 2/3

Original Principal Amount

Original Note Term (From-To)

Loan Interest rate

Current Principal Balance

Lien position (if known, 1st, 2nd, 3rd, etc.)

Monthly Payment

Due Date of Missed Payment

Number of Payment now past due

Amount of Late Charges

Number of Late Charges now due

Have you made any advances (senior liens, property taxes, insurance, attorneys)?

If yes, to whom and what for:

Date and amount of each advance

Reasons for default check all that apply):

If failure to pay taxes, maintain property, insurance, or other, provide details below:

Are senior liens in foreclosure?

Does the property generate rents?

Other necessary information:

Step 3/3

Your name (and company if applicable)

Address

Telephone No.

Fax No.

E-mail(s)