How did you hear about us? (If referred by someone, please type the name of the person who referred you.) SSL Salutation Your Name Your Home Telephone Number Your Cell Telephone Number Your Work Telephone Number How do you prefer to be contacted? What is the best time of day to contact you? At Home9am -11am 11am – 1pm 1pm – 3pm 3pm – 5pm By Cell Phone9am -11am 11am – 1pm 1pm – 3pm 3pm – 5pm At Work9am -11am 11am – 1pm 1pm – 3pm 3pm – 5pm
Your Email Address Are you currently late with any of your mortgage payments? If yes – how many payments have you missed including this month? 1st Mortgagend Mortgage Can you currently afford to pay all of your monthly bills and your mortgage payment(s)? Do you have a commitment to remain in your home? How long have you owned your home? When did you last refinance your loan? Please, briefly describe what event or events have occurred to cause you to fall behind on your mortgage payments. Have you received any letters from your Mortgage Lender’s attorneys or received any court documents? Is there a Foreclosure Sale date set for the sale of your home? If yes – what is the date of the Foreclosure Sale? Month Homeowner’s Information: Your Name Is Your Name on the Mortgage? Your Spouse’s / Other’s Name Is Your Spouse’s / Other’s Name on the Mortgage? How many Adults in your household? Address Where You Live: Street Address City, State and Zip Code Address of property behind on payments: Street Address City, State and Zip Code Mortgage Lender’s Name(s): 1st Mortgage Lender’s Name 2nd Mortgage Lender’s Name (if any) Have you ever had a Loan Modification in the past? Has it been greater than 2 years since the last Loan Modification? Monthly Mortgage / Other Loan Payments: 1st Mortgage Payment $ What type of loan is your 1st Mortgage? Is your 1st Mortgage a Fixed Rate or Adjustable Rate Mortgage? What is your current interest rate? Are Real Estate Taxes and Homeowner’s Insurance included with your Mortgage Payment? 2nd Mortgage Payment (if any) $ 1st Automobile Loan Payment $ 2nd Automobile Loan Payment $ Personal Loans / Student Loans and any Finance Company Payments (monthly payments combined) $ Monthly Credit Card Payments (combined) $ Other Monthly Loan Payments $ Other Monthly Payments: Monthly Food Expenses $ Monthly Electric and Heating Bill Expenses (combined) $ Monthly Water / Sewer / Garbage Expenses $ Monthly Telephone Expense $ Monthly Cell Phone Expense $ Monthly Cable TV / Satellite Expense / Streaming Services $ Monthly Homeowner’s Association or Condo Fees $ Monthly Gasoline Expense $ Monthly Public Transportation / Car Pooling and Parking Expenses $ Monthly Automobile Insurance Expense $ Monthly Clothing / Dry Cleaning Expense $ Monthly Home Security / Home Alarm System $ Monthly Day Care Expenses $ Monthly Child Support Expenses $ If you have Child Support Expenses – Monthly Clubs / Sports / Gym and Hobby Expenses $ Monthly Entertainment / Spending Money $ Monthly Church Contributions $ Monthly Prescription / Medical Expenses $ Other Monthly Expenses $ Other Monthly Expenses $ Monthly Household Income: Your Monthly Income (take home pay / net income) $ Your Spouses or Other’s Monthly Income (take home pay / net income) $ Other Monthly Income $ Other Monthly Income $ Bankruptcy Information: Have You Filed Bankruptcy Since You Bought Your Home? If Yes – Was the Bankruptcy Completed? Amount Behind / Money Saved: Approximately how much money will it take to bring your mortgage payments current? How much money have you been able to save to give to your mortgage lender? I/WE hereby authorize the release of this information to United Capital Mortgage Assistance and its foreclosure prevention associates only, and therefore do not authorize the release of this information to any other person, person(s), corporation, entity or otherwise. Your Name Call me/us right away.
Confidentiality Policy
