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Loan modification process can we very complex, and difficult to understand.

We dedicated out time to make this process easier on you.

This application is easy to understand and it only takes 20 minutes to complete.

Please answer every question, be specific and accurate in your answers - Your Modification Success depends on it.

If you are not sure of what the question is asking, or don't know the answer, you can Contact Us, or leave it blank.

Borrower First Name: *

Borrower Last Name: *

Co-Borrower First, Last Name:

Email:: *

Home Phone::

Total Number of Dependants::

Property Address:

First Lienholder(Bank) Name::

First Lienholder Account Number::

First Lienholder Current Interest Rate (i.e. 7.25%) ::

First Lienholder Current Balance::

Second Lienholder Name::

Second Lienholder Account Number::

Secondary Lienholder Current Balance::

Property Current Market Value::

Combined Checking, Savings, Money Mkt Account Balances:

Combined Mutual Fund, 401k, IRA/SEP, 403b Balances::

Other Real Estate Investment Values::

Primary Borrower Employer Name::

Primary Borrower Employment Title::

Secondary Borrower Employer Name::

Secondary Borrower Employment Title::

Please list any Repairs needed on the House(i.e. carpet $4,000, roof $8,500, door $300, etc)::

Is the house currently listed for sale?:

Yes
No

What is the Broker/Agent Name, Phone & Listing Price:

Have You Filed For Chapter 7 Bankruptcy? If so, what date?:

If Your Chapter 7 Bankruptcy Has Been Discharged, Please Provide Discharge Date:

Is This Property Your Primary Residence?:

Yes
No

Do You Currently Occupy This Property?:

Yes
No

I Believe My Situation Is::

Inability To Pay My Mortgage Is Due To: (list applicable) Reduced Income, Business Failure, Unemployment, Too Much Debt, Rate Adjusted, Divorce, Death in Family, Illness, Disability:

Please Give Us A Detailed Explanation Of Your Hardship::

Primary Borrowers Gross Monthly Income:

Primary Borrowers Net (take home) Monthly Income:

Secondary Borrowers Gross Monthly Income:

Secondary Borrowers Net (take home) Monthly Income:

Combined Child Support, SS/Alimony/Rentals/Other Income:

Primary Lienholder Monthly Mortgage Payment (excluding taxes and insurance)::

Secondary Lienholder Monthly Mortgage Payment (excluding taxes and insurance)::

Monthly Home Owners Insurance Payment::

Monthly Property Tax Exepense::

Home Owners Association Monthly Dues::

Monthly Utility Expenses (gas, electric, water, garbage, phone)::

Monthly Cable/Internet Expenses::

Monthly Home Maintenance Expenses (lawn care, pool care, cleaning supplies, etc.):

Monthly Automobile(all cars) Payment:

Monthly Automobile Insurance For All Vehicles::

Monthly Automobile Gas & Maintenance Expense For All Vehicles:

Monthly Life Insurance Payment::

Monthly Health Insurance Payment::

Monthly Unreimbursed Medical Care Expenses::

Monthly Grocery Expenses::

Monthly Dining Out Expenses::

Monthly Church, Charity Donation:

Monthly School Expenses (child/adult)::

Monthly Clothing/Dry Cleaning Expenses:

Monthly Health Club, Hair Care, Other Expenses:

Monthly Movie/Hobby/Shows/Entertainment Expenses:

Monthly Alimony/Child Support Expense:

Monthly Min. Combined Credit Card Payments:

Monthly Student/Personal Loan Payments:

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