1. LEAD INTAKE

Date of Call

Intake Agent

Lead Source

Intake Notes

2. BROKER / PRINCIPAL

Name

Company

Role

Email

Phone

Preferred Contact

3. BORROWER

Borrower Name

Co-Borrower

Status

Email

Phone

Mailing Address

4. PROPERTY / COLLATERAL

Address

City

State

ZIP

Property Type

Occupancy

Lien Position

Est. Value ($)

Valuation Source

Auto-calc: LTV updates when UPB and Value are present.

5. NOTE TERMS

Original Balance ($)

Interest Rate (%)

Original Term (months)

First Payment Date

Maturity Date

Monthly P&I ($)

Current UPB ($)

Remaining Term (months)

Next Due Date

6. PAYMENT & ESCROW

Taxes Escrowed?

Insurance Escrowed?

Monthly Escrow ($)

Total PITI ($)

Late Fee

Prepayment Penalty?

PITI auto-adds P&I + Escrow.

7. PERFORMANCE / SEASONING

Seasoning (months)

# Lates (12 mo)

Last Paid Date

Arrears / Deferred ($)

Bankruptcy?

Loan Modified?

Performance Notes

8. SERVICING & PAYOFF

Current Servicer

Servicer Acct #

Payment Method

Monthly Due Day

Payoff Good-Thru Date

Reinstatement ($)

9. DOCUMENTS CHECKLIST

Upload File 1

Upload File 2

Mailto cannot attach files automatically; file names are included in the email body.

10. DERIVED METRICS

LTV (%)

Remaining Payments

Calc Notes

11. INTERNAL NOTES

12. ATTESTATION / SIGNATURES

Your Name

Date

I certify the information provided is accurate to the best of my knowledge.