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This is a detailed application. It will provide with the information we need to begin consulting with you. We need you to be as thorough as you can so that we can help you through this process. There are several required fields marked with an asterisk. Please be as detailed as you can.

* indicates a required field.

General Information:

First Name: *

Middle Name:

Last Name: *

Co-Applicant First Name:

Co-Applicant Last Name:

Referred by:

Contact Information: (We must have at least one phone number for you! We would appreciate an email address as well as it helps with communication. *)

Home Phone:

Cell Phone:

Email Address: *

Preferred Contact Method:

Phone

Best time to reach you?

Morning

Afternoon

Evening

Doesn't matter

Address Information:

Address Line 1: *

Address Line 2:

City: *

State: *

Zip/Postal Code: *

Property in Foreclosure:

The address of the property is the same as my above address:

Property Address Line 1: *

Property Address Line 2:

Property City: *

Property State: *

Property Zip/Postal Code: *

Mortgage Information:

First Mortgage Lender: *

Mortgage Type: *

FHA

Conventional

Other

First Mortgage Loan Number:

Months Behind: *

Second Mortgage Lender:

Months Behind:

Purchase Price of Home:

When did you purchase the home?

Owed / Balance:

Estimated Market Value:

Foreclosure Lawyer and Contact Info:

Foreclosure Sale Date:

in the format of "mm/dd/yyyy"

Detailed reason as to why you are behind in these payments. Detail here is important:

Employment Information:

Current Employer:

Years in Current Job:

Work Phone:

Part Time Job:

Years in Part Time Job:

Co-Applicant Employer:

Co-Applicant's Years in Job:

Co-Applicant's Part Time Job:

Co-Applicant's Years in Part Time Job:



Income Information:
Your (Monthly) Take Home Pay:
Co-Applicant's (Monthly) Take Home Pay:
Other (Monthly) Income:
Other Monthly Income Description:
Total Income:
Estimated Avg. FutureMonthly Income:
Cash on Hand for Negotiation:

Information on Dependents:
(age of each)

Expense Information: Please enter MONTHLY Information!
First Mortgage or Rent Monthly Payment:
Second Mortgage or Rent Monthly Payment:
Electricity Bill:
Heating Bill:
Water and Sewage Bill:
Estimated Telephone Bill:
Cable TV:
Newspaper/Periodicals/Books:
Medical & Drug Expenses:
Auto Payments:
Transportation:	(Gas, Bus Fare, Cab Fare, etc.)
Auto Insurance:
House/Homeowners Insurance:
Property Taxes:
Alimony, Maintenance or Support:
Child Care, School Tuition:
Clothing:
Uniform/Laundry/Cleaning:
Religious and/or Charity:
Misc Creditors Monthly Payments:
Chapter 13 Payment:
Food:	(Include Groceries, Eating Out etc.)

Total Monthly Expenses:
Total Income:
Net Income: