Homeowner Questionnaire

How many individuals are listed as owners of the house?

FIRST CO-OWNER

Owner Name

Are you married?

Spouse Name

Daytime Phone

Evening Phone

Cell Phone

Fax

Best time to Call

SECOND CO-OWNER

Owner Name

Are you married?

Spouse Name

Daytime Phone

Evening Phone

Cell Phone

Fax

Best time to Call

Who is on the title?

Reason for delinquency?

In Bankruptcy?

Please specify the type of bankruptcy

Discharged?

Property Release from BK?

Currently living in Property?

Want to stay?

Since you are staying in your home, please provide a list of your current financial obligations. This information is necessary for us to assist you effectively.

FIRST CO-OWNER

Employer

Position

Years in Position

Monthly Wages

Other Income

SECOND CO-OWNER

Employer

Position

Years in Position

Monthly Wages

Other Income

PROPERTY INFO

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Property Value

LIEN INFO

1st Mortgage Holder

Account Number

Contact Name

Phone

FAX

Date of Mortgage

Original Amount of Mortgage

Interest Rate

Term

Balloon Date

Amount

Monthly Payment

Principal/Interest

Taxes

Taxes Escrowed?

Insurance

Insurance Escrowed?

Total PITI

Averages

Unpaid Principal

Attorney Fees

TOTAL NOW DUE

Our Offer

Accepted Price

In Default?

Number of Payments Behind?

Foreclosure proceedings been initiated?

Estimated Sheriff's Sale Date

2nd Mortgage Holder

Account Number

Contact Name

Phone

FAX

Date of Mortgage

Original Amount of Mortgage

Interest Rate

Term

Balloon Date

Amount

Monthly Payment

Principal/Interest

Taxes

Taxes Escrowed?

Insurance

Insurance Escrowed?

Total PITI

Unpaid Principal

Averages

Attorney Fees

TOTAL NOW DUE

Our Offer

Accepted Price

In Default?

Number of Payments Behind?

Foreclosure proceedings been initiated?

Estimated Sheriff's Sale Date

TAXES & OTHER LIEN

Property Tax

per half a year

Delinquent Amount

Other lien or judgments?

List of creditor(s) and the amount of lein(s)

Currently Listed?

Contract Expires

Agent Name

Services

Programs

Services

Programs

Homeowner Questionnaire

Since you are staying in your home, please provide a list of your current financial obligations. This information is necessary for us to assist you effectively.

Homeowner Questionnaire

Since you are staying in your home, please provide a list of your current financial obligations. This information is necessary for us to assist you effectively.

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