Las Vegas Mortgage and more.

Client Questionnaire and Assistance Agreement

NAME:
PHONE		Best time to call:
ADDRESS:		PROPERTY ADDRESS (If different from mailing address)

Value Estimate
CURRENT LENDER(s):
Balance 1st		Balance 2nd
Balance 3rd
IS THIS YOUR HOME OR AN INVESTMENT?		home investment
ARE YOU IN FORECLOSURE RIGHT NOW?		yes no
WHEN WAS YOUR LAST PAYMENT MADE?
IS THE PROPERTY VACANT OR OCCUPIED?		vacant occupied
Tenant Occupied?	yes no

HAVE YOU RECEIVED A NOTICE OF DEFAULT OR A COLLECTION LETTER FROM YOUR LENDER OR LOAN SERVICER? yes no
If the answer is “yes”, please explain:
WHAT DO YOU WANT FROM YOUR LENDER? Keep your house & make a new agreement Give up house and limit financial responsibility Other: (Please Describe) HOW IS YOUR CREDIT: Great Fair Poor (score ) ARE YOU EMPLOYED CURRENTLY? yes no

Disclaimer: We strive to keep all matters confidential and we shall only speak to the listed personnel regarding your assistance program.

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