Please take the time to fill out this information form. I want to serve you to the best of my ability and this information will allow me to evaluate your situation and personalize the time I spend with you. I also respect your privacy and do no share the information provided with anyone without your permission. I look forward to assisting you.
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| Contact Info: |
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*Your Name(First, Last): |
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Spouse Name |
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*Property Address: |
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*City: |
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State: |
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Zip: |
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*Phone 1: |
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Phone 2 |
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Best Time to Contact: |
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*E-Mail: |
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| Property Info: |
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Type of Property: |
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Approximate Year Built: |
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Bedrooms: |
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Bathrooms: |
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Approximate Square Footage: |
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Parking: |
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Spaces: |
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Rate Overall Condition: |
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Estimated Value of Home? |
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| Mortgage Info: |
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1st Mortgage Company |
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Monthly Payment |
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Months Behind |
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2nd Mortgage Company |
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Mortgage Amount |
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Monthly Payment |
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Months Behind |
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Are there any other Mortgages/Liens/ Judgments recorded against your home? |
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Are you in foreclosure? |
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If you didn't have to worry about past due amounts could you afford your current monthly payment and all other expenses? |
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Have you filed for Bankruptcy since you have owned your home? |
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If you have filed, has your bankruptcy been discharged or dismissed? |
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Are you interested in keeping or selling your home? |
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*How did you find us? |
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*If you found us through an advertisment, what is the extension of the phone number located on the piece? |
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Your Situation: |
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Briefly explain your situation:
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Financials: |
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Total Current Net Monthly Income: |
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Total Current Monthly Expenses: |
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Cash Available to put toward Mortgage Balance: |
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Thank you for submitting your information. We will be in contact with you shortly. |
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