Name
Day Phone
Evening Phone
Email Address
How did you hear about us? 

If Other, Where?


Let's talk about the numbers... Property Identification
Street Address
City
State
Zip Code
Subdivision Name (if any)
How much do you owe on your property?
How much is the property worth?
1st Mortgage
Balance*
1st Mortgage
Payment*
1st Mortgage Holder
2nd Mortgage
Balance
2nd Mortgage
Payment
2nd Mortgage Holder
Do you have an equity line on this property?
Balance
Payment
Holder
So the total monthly payment is

Are the payments current? yes no
If no, how far behind? (If you don't know for sure, can you estimate?)
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1st Mortgage
# of pmts/months
$ amount
Penalities/Fees included?
yes no
2nd Mortgage yes no
Equity Line yes no
Date received
Have you received a foreclosure warning letter from your lender? yes no
Have you received a Notice of Foreclosure? yes no
Has a Foreclosure Sale Date been set?  yes no
If yes, what is the sale date?

Is the property attached to a bankruptcy? yes no
Are there any other comments you have that would enable us to help you better?
Is the property occupied unoccupied
Does the property need repairs? yes no
If "yes," what kind?

Describe your property...

Ranch 2-Story Split
Foyer
Split
Level
Sq. Footage

All
Brick
Brick
Siding
Wood
Siding
Vinyl
Siding
Stucco
Lot Size

# of Bedrooms # of
Baths
Formal
Living Rm
Formal
Dining Rm

Fireplace Ceiling
Fans
Fenced Pool Sewer
Septic

Crawl
Space
Slab Basement Finished Age of Roof
Unfinished

Central Air Number of Units

Garage On-Street Parking Number of Cars
Carport Off-Street Parking

When was the property built?
How long have you owned the property?
Is the property listed with a real estate agent? yes no
If yes, when does the listing expire?


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