Bankruptcy Form Processing

Name:
Address:
City, State, Zip:
Phone:
Cell Phone:
E-mail:

Property Address If Different:
Balance on First Mortgage:
Lender Name:
Balance on Second Mortgage:
Lender Name:
Other Liens on Property:
Estimate of Property Value:
Have you received a Lis Pendens or Notice of Default? Yes  No
How much are your monthly payments?
Existing Mortgage Rate:
Fixed Rate  Adjustable Rate
What is included in payments:
Interest Only
Principal and Interest
Insurance
Taxes
How far behind are you on payments: $
What is the total payoff amount? $
What is the reinstatement amount? $

Auction Date:

Reason For Delinquency:

Do you want to stay in your home? Yes No

If you want to sell your home please answer the following:

Type of Property:
Single Family Home
Condo
Townhouse
Mobile Home
Number of Bedrooms
Number of Bathrooms
Square Footage
Total living Square Footage
Total Garage Square Footage
Pool? Yes No  Above Ground  In Ground
Lot Size
Property Condition:
Poor
Fair
Good
Excellent
Other Comments