Workout Submission

DO NOT USE COMMAS IN THE DOLLAR AMOUNT BOXES!!

Entering non-numerical characters (dollar signs, commas, dashes, letters A-Z) into boxes with dollar signs will result in the amounts being zero and your application processing will be delayed. Use the Notes/comments section for additional explanations.
* indicates required fields.
Your Name : (First/M/Last) :
*
Spouse Name : (First/M/Last) :
Address :
*
City/State/Zipcode :
 *
Home Phone Number :
 - - *
Cell Phone Number :
 - -
Email Address :
 (Optional but preferred)
Property Address : (if different) :
Employer :
Work Phone :
Spouse Employer
Work Phone :
Dependent Ages :
Purchase Price :
 $ *
Year Purchased :
 *
Last Refinance :
 (Year or none)
Amount of Refinance :
 $
Have You Filed Bankruptcy Since You Bought Your Home? :
*
If Yes - When Was it Completed or a Stay of Relief Ordered? :
(Example : 4/06)
 
What type of bankruptcy? :
1st Mortgage Lender :
 *
1st Mortgage Loan Type :
 *
1st Mortgage Balance :
 $ *
1st Mortgage Payment :
 $ *
1st Mortgage Interest Rate :
 % * (Example : 9.25)
Property Taxes Included? :
Insurance Included? :
*
Has the Lender paid any taxes or insurance? (Not including escrow) :
*
If Yes above, how much? :
$ Dollar Amounts Only!
Amount Behind :
 $ * Dollar Amounts Only!
Legal Fees :
 $ * Dollar Amounts Only!
2nd Mortgage Lender :
2nd Mortgage Loan Type :
2nd Mortgage Balance :
 $
2nd Mortgage Payment :
 $
Amount Behind :
 $
Market Value :
 $ *
Cash on Hand :
$
Lender's Foreclosure Attorney :
Phone Number :
FORECLOSURE DATE :
Have you made any previous arrangements with your lender to settle the arrearages, or are you in the process of negotiating with them? :
No Yes *
What arrangements, if any, have you made or are in the process of making? (i.e. Has the lender made you an offer?) :
List Arrangement Details or type NONE
(1) Debtor's Monthly Take Home Pay :
$ Calculator
(2) Spouse's Monthly Take Home Pay :
$
(3) Other Monthly Income
(Child Support, Social Security, Disability Income, etc.) :
$
(4) Rental Income :
$
(a) 1st Mortgage Payment :
$ *
(b)2nd Mortgage Payment :
$
(c) Total of Other Mortgage and Property Payments :
$
(d) Electricity Bill :
$
(e) Heating Bill :
$
(f) Water/Sanitation Bill :
$
(g) Telephone Bill :
$
(h) Food :
$
(i) Medical and Drug Expenses :
$
(j) Auto Insurance :
$
(k) Homeowners Insurance if Not Included in Payment :
$
(l) Property Taxes (if not included in mtg payment) :
$
(m) Cable Television :
$
(n) Transportation (Gas, Bus, Other) :
$
(o) Alimony, Maintenance, or Support :
$
(p) Child Care, College or Private School Tuition :
$
(q) Religious and/or Charity :
$
(r) Automobile Payments :
$
(s) Total MINIMUM Payments of Credit Cards :
$
(t) Other Miscellaneous Creditors Total of Monthly Payments :
$
(u) Chapter 13 Payment :
$
(v) Other :
$
Comments :