Note Investor Registry Application

Company Name

Your First Name

Your Last Name

Phone

Fax

Email

Website

Street address (line 1)

Street address (line 2)

City

State / Province / Region

ZIP / Postal Code

Your Time Zone and Business Hours

Geographic area(s) or states in which you buy notes:

Geographic area(s) or states in which you do NOT buy notes:

Maximum investment in one note:

Minimum investment in one note:

Do you buy pools/portfolios?
YesNo

Maximum portfolio size:

Minimum portfolio size:

Do you close your own transactions?
YesNo

Will you purchase partial balances? If so, please describe your requirements

Do you have a minimum discount? If so, please describe

What is your minimum payor's credit score?

Will you protect a broker on future or partial transactions that may be marketed directly to you without the broker's knowledge?
YesNo

Do you require the escrow account to be moved when you purchase the note?
YesNo

Check the type of notes you purchase:
Single Family HousesMulti Family HousesCondosVacation/Second HomesSmall Commercial (eg., small office buildings)Large Commercial (eg., shopping centers)Commercial Land WITH ImprovementsCommercial Land WITHOUT ImprovementsResidential Land of any size WITH ImprovementsResidential Land of any size WITHOUT ImprovementsResidential Land 20 acres or less WITH ImprovementsResidential Land 20 acres or less WITHOUT ImprovementsResidential Land 40 acres or less WITH ImprovementsResidential Land 40 acres or less WITHOUT ImprovementsResidential Land 80 acres or less WITH ImprovementsResidential Land 80 acres or less WITHOUT ImprovementsFarm Land WITHOUT Single Family HousesUnimproved Raw Land of any sizeUnimproved Raw Land 40 acres or lessUnimproved Raw Land 80 acres or lessUnimproved Raw Land 160 acres or lessIndustrial PropertyMobile Homes WITH LandMobile Homes WITHOUT LandCo-opsChurchesDivorce LiensMarital LiensOwelty LiensReperforming Residential Notes -- No Payor BKReperforming Residential Notes -- Payor BKReperforming Non-residential NotesHard Money LoansPre-settlement lawsuitsTimesharesTavernsService StationsSecond Position LiensThird Position LiensSmall Seconds Behind Large Firsts80-10-10'sWraps/AITDsLotteriesContest Revenue StreamsStructured SettlementsAnnuities"Que Tam" (whistle blower paper)TrustsInheritancesWorkmens Comp AwardsCommodity Credit Corp. PaymentsMilitary PensionsAccounts ReceivableRealtor CommissionsBusiness Notes (no real estate)Real Estate LeasesEquipment LeasesTax CertificatesJudgmentsContracts/Home ImprovementsRoyaltiesAutosBoatsAircraftUnsecuredCasino WinningsCorporation as PayorNon-Profit Organization as PayorDistressed/Defaulted PaperPartial AssignmentsSimultaneous ClosingsAccounts Receivable FundingMedical ReceivablesPurchase Order FundingCorporate Buy-outsPartnership Buy-outsNotes from Mergers and Acquisitions

List other types of notes you buy if not listed above:

Do you have immediate liquid funds?
YesNo

Do you lend money?
YesNo

Do you work with brokers exclusively?
YesNo

If you are purchasing the Basic Listing, enter up to 100 words of additional copy in this box (use this to make your company stand out). If you are purchasing the Enhanced Listing, enter up to 500 words. For the Enhanced Listing, indicate what text enhancements you want and where (headlines, bold, caps, italics, underlining, special characters such as checkmarks, etc., and color [in the e-Registry only; the Print Edition is black-and-white]). For the Enhanced Listing please attach your logo below.

Upload Your Company Logo File (for Enhanced Listing Only)

Description of Product or Service (100 Word Basic; 500 Word Enhanced)

Payment Amount*
Basic Listing $250.00Enhanced Listing $445.00

Credit Card #

Exp Date

CVV

Prefer To Send A Check?

Yes, I will Send a Check

Certification

I HEREBY CERTIFY THAT AT LEAST 50% OF OUR BUSINESS INVOLVES PURCHASING FOR OUR OWN ACCOUNT OR WITH OUR OWN FUNDING SOURCES (in other words, you affirm that you are not selling to the large national firms most brokers already know about).

Your Name*

First

Last

Title