Request a Quote

Use our online form to request an in-depth quote & analysis

PDF Version of Form

Click the button below to download a printable PDF version of this form for faxing

Download PDF Version

Submit Form Online For a FREE Quote

Please complete this form as fully as possible and we will contact you with the cash value of your mortgage as quickly as possible.


Your Name (required):

Your Email (required):





Day Phone (Required):

Evening Phone (Required):

Best Time to Call:

Property Type:

Sale Date (MM/DD/YYYY):

Original Sale Price:

Down Payment:

Current Balance:

Interest Rate:

Original Term:

Balloon Amount (If Applicable):

Balloon Date (MM/DD/YYYY):

Payment Amount:

Payment Schedule:

Payments Current?

Credit Score of Payer (if available):

Full Address of Property:

Brief Description of Property:

Motivation for Selling Your Note/Mortgage:

Immediate Cash Needs?

How Did You Hear About Us? (Required)

*Information submitted through this form will be kept confidential by the American Equity Funding staff. This form resides on a secure server which is designed to restrict access to its data. However, no computer system is completely secure. Neither American Equity Funding nor WebSite Warehouse shall be liable for any damages, direct or consequential, arising from the use of this form.