State Request FormState Request Form

Advanced Seller Data Services

“Providing the very best lists for note brokers and investors”

15685 SW 116th AvenuePhone: 1-800-992-4536

Suite 136Fax: 503-549-0589

Tigard, OR 97224e-mail:

Please complete and fax or scan or e-mail with the Order Form and License Agreement

State Request Form

Name: Company: .

Order dollar limit: (minimum $200) $: Include Second Position Loans? Yes No

We will not provide 2nds unless you request them

Instructions:

Enter the time period with the starting and ending month and year you wish to purchase

In Min Loan Amount Column enter the minimum beginning loan balance you want.

In Priority column place a "1" by the states you want most, "2" states desired second most; "3" states that are third priority etc

If you do not want a state, leave the row blank

Texas, California and Florida create over half of all seller carrybacks, You should pick most other states if you don’t want any of the big three states. If you do not have enough records from the states and time period you chose, we will fill the order with records matching as closely as possible to the records you ordered.

Fax back with Order Form and License Agreement to 503-549-0589or scan and e-mail forms to

We pick the best records within the ranges in the priority you provide- records not sent to others are selected first

We track all records sent to you and make certain you do not receive the same record in different orders

We will e-mail your records to the address provided on the order form unless other instructions are provided.

Loan Dates: From Through: .

Min LoanMin Loan

StateAmountPriorityStateAmountPriority

Alabama / Missouri
Alaska / Montana
Arizona / Nebraska
Arkansas / Nevada
California / New Hampsh.
Colorado / New Jersey
Connecticut / New Mexico
Delaware / New York
District of Col. / North Carolina
Florida / North Dakota
Georgia / Ohio
Hawaii / Oklahoma
Idaho / Oregon
Illinois / Pennsylvania
Indiana / Rhode Island
Iowa / South Carolina
Kansas / South Dakota
Kentucky / Tennessee
Louisiana / Texas
Maine / Utah
Maryland / Vermont
Massachusetts / Virginia
Michigan / Washington
Minnesota / Wisconsin
Mississippi / Wyoming

11/15/2018