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| BORROWER |
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| First Name: |
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| Middle Initial: |
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| Last Name: |
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| Home Phone # |
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| Cell Phone # |
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| Work Phone # |
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| Email: |
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| Co-Borrower First Name: |
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| Middle Initial: |
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| Last Name: |
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| Home Phone # |
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| Cell Phone # |
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| Work Phone # |
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| Email: |
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Married to Borrower |
| Best time to contact you? |
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| Best form of contact? |
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| SUBJECT PROPERTY |
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| Street Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Type of Property: |
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| Occupancy: |
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| Date of Purchase: |
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| Purchase Price: |
$ |
| How much do you think your home is worth in today's market? |
$ |
| Have you refinanced since you purchased the home? |
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| Is the property listed for sale? |
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| Are you behind on your mortgages? |
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| Is your mailing address different than the subject? |
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| 1ST MORTGAGE |
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| How much do you owe on your 1st mortgage (total principal balance)? |
$ |
| Who is your mortgage with (or servicer)? |
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| What kind of loan do you have? |
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| What is your current interest rate? |
% |
| Is your mortgage adjustable or fixed and for how long? |
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| Has your mortgage adjusted?: |
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| 2ND MORTGAGE |
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| Do you have a second mortgage or HELOC? |
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| Amount of mortgage or HELOC? |
$ |
| PROPERTY TAXES AND INSURANCE |
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| Are your property taxes included in your mortgage payment? |
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| Is your property insurance included in your mortgage payments? |
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| FINANCIALS |
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| Borrowers Employment: |
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| Name of Company or Employer: |
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| Gross Monthly Salary/Wage/Income: |
$ |
| Overtime: |
$ |
| Bonus/Commissions: |
$ |
| Social Security: |
$ |
| Interest/Dividends: |
$ |
| Rental Income: |
$ |
| Other: |
$ |
| Total Gross Income: |
$ |
| Total Net Income (after taxes): |
$ |
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| Co-Borrower Employment: |
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| Name of Company or Employer: |
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| Monthly Salary/Wage/Income: |
$ |
| Overtime: |
$ |
| Bonus/Commissions: |
$ |
| Social Security: |
$ |
| Interest/Dividends: |
$ |
| Rental Income: |
$ |
| Other: |
$ |
| Total Gross Income: |
$ |
| Total Net Income (after taxes): |
$ |
| Other Household Income (contributions, other): |
$ |
| Total Monthly Household Income: |
$ |
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| ASSETS (Totals for both borrower and co-borrower) |
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| Real Estate: |
$ |
| Checking Account: |
$ |
| Savings Account: |
$ |
| IRA/Keough Account: |
$ |
| 401K/ESOP Account: |
$ |
| Stocks, Bonds, CD's: |
$ |
| Total Asset Value: |
$ |
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| LIABILTIES (total for both borrower and co-borrower) |
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| Mortgages (1st & 2nd): |
$ |
| Taxes and Insurance: |
$ |
| HOA Dues: |
$ |
| Car Loans: |
$ |
| Credit Cards: |
$ |
| Other Loans: |
$ |
| Total Liabilities: |
$ |
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| LIVING EXPENSES (total for both borrower and co-borrower) |
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| Child Care: |
$ |
| Cable/Satellite: |
$ |
| Telephones: |
$ |
| Medical Expenses: |
$ |
| Total Utilities: |
$ |
| Food: |
$ |
| Auto Gas/Maintenance: |
$ |
| Auto Insurance: |
$ |
| Other: |
$ |
| Other: |
$ |
| Other: |
$ |
| Total Expenses: |
$ |
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| HARDSHIP |
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| What would you like to do with your home? |
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| Have you spoke to your lender about modifying your loan? |
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| Please explain your financial hardship (how did you get into this situation? why should your lender modify your loan?) |
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| Do you own more than one property? |
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| Have you ever been late before you experienced you financial hardship? |
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| Have you ever filed for bankruptcy or are currently involved in any bankruptcy proceedings? |
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| If yes to the above question please explain when you filed for BK and when it was discharged. |
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| Other Case Notes (anything else that we should know that we didn't ask that you think would be pertinent to your case.) |
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