Contact Information

Homeowner's full name*:  

Co-homeowner's full name:  

Email*:  

Primary Phone*:       Mobile Phone:  

Interested in* (check all that applies):  Loan modification   Mediation   Bankruptcy

Preferred appointment date*:     select

Preferred appointment time*:   9 am 9:30 am 10 am 10:30 am 11 am 11:30 am 12 pm 12:30 pm 1 pm 1:30 pm 2 pm 2:30 pm 3 pm 3:30 pm 4 pm 4:30 pm 5 pm 5:30 pm-Henderson Only 6 pm-Henderson Only

Preferred location*:
 Downtown (BK & Mediation only)  Henderson (Loan Mod/BK/Mediation)  Northwest Office (BK & Mediation only)


Property Information

Subject property*:     Enter N/A if renting.

City:       Zip Code:  

Occupancy:Principal residence   2nd home   Investment   

Estimated Value::  


Finances

First Mortgage balance:  $

Lender/Servicer*:     Enter N/A if renting.

Year loan originated:  

Monthly mortgage / rent payment including Tax & Hazard Insurance:* $

Monthly Homeowner's association (HOA)*: $

Current Interest Rate: 

Existing Loan type (check all that apply):
Principal & interest   Interest only   Option arm   ARM   15 years   30 years
40 years   Conventional   FHA   VA

Second mortgage balance (if any):  $

Second mortgage monthly payment:  $

Current interest rate:  

Lender/Servicer*:     Enter N/A if renting.


Monthly Income

Homeowner's monthly gross income (before deductions):  $

Co-owner monthly gross income:  $


Expenses

Estimated monthly total household expenses:  $

Estimated total balance of unsecured debts*:  $


Additional Information

Are You Behind on Your House Payment?  YES   NO   N/A

How Many Months Behind?    current 1 month 2 months 3 months 4 months 5 months 6 months

Have you contacted your lender?  YES   NO

Do you have a genuine financial Hardship?  YES   NO

Please tell us briefly your situation:

In order for us to be able to evaluate your situation and provide you with options, please bring the following:

1. Mortgage statement(s)
2. 2 most recent proof of income documentation of all homeowners in the NOTE. If self employed, 6 months of Profit & Loss.
3. Any notices received from your lender (if any).