[NOTE: The following sample questionnaire is used with the New York Mortgages Library. If you ordered the library for some other jurisdiction, some of the questions and terms would be different.]

NOTE AND MORTGAGE QUESTIONNAIRE

Identify Maker of NOTE:
Name(s):

Address(es):


Phone:
__male __female __corporation __partnership __LLC
Identify Payee:
Name(s):

Address(es):


Phone:
__male __female __corporation __partnership __LLC
You represent: __Maker __Payee

If the other party is represented by an attorney:
Name:
Firm:
Address:

Phone:

Date of NOTE:

Maturity Date:

Original Principal Amount - $

Interest: ___% per annum
__float with prime (__above/__at/__below) - bank:
__360 day basis for computing interest
__rate changes on specific dates:
Periodic Payments: - $
per __month/__quarter/__semi-annual/__annual
vs __due on demand
vs __due on maturity date
The NOTE is -
__unsecured
__secured by Security Agreement
__secured by Mortgage
RE Mortgage

Identify premises -
Street Address:
Common Name:
City:
County:
State:
Number of parcels: __one __other:
Section:
Block:
Lot:
[metes and bounds will be Exhibit A]

USE of premises -
   __an apartment house       __industrial/manufacturing
__garden apartments __mixed use - office and com'l
__an office building __mixed use - office and res'l
__a shopping center __mixed use - res'l and com'l
__a house
__vacant land __other:
ESTATE -
__fee title - both land and buildings
__land only
__buildings
__a leasehold estate
__leasehold and fee title
__leasehold and land
__leasehold and buildings

Identify any Ground Lease:


Is the Mortgage -
__a first mortgage
__a subordinate mortgage (__wraparound)
Identify EXISTING mortgage:


__it is a PURCHASE MONEY mortgage

__prepare just a RIDER (rather than entire mortgage) - number of last Article of printed form:

__prepare a short form of mortgage

Do you want the following provisions -
__non-recourse
__expressly prepayable without penalty
__a prepayment premium: ___% of principal
__higher rate of interest after default: ___%
__a fixed late charge: ___% of amount due
__due on sale
__prohibit any further mortgage
__must maintain flood insurance
__escrow deposits for taxes & insurance
__to sign non-disturbance agreements with tenants
__to provide title insurance to Maker
__payment of attorneys' fees if foreclosed:
__prepare an Environmental Indemnity Agreement