Short Sale Questionnaire

Your Name (required)

Your Email (required)

Phone Number

City

State

Zip Code

Is this your primary residence?  Yes No

Explanation of financial hardship

Months behind in payments

Original purchase price

Year purchased

First mortgage servicer/banker

Payoff or balance on first loan

Second mortgage servicer

Payoff or balance on second loan

Payoff or balance on other loans (total)

Today's approximate market value

Has a notice of default or trustee sale been posted?  Yes No

Have you ever refinanced to cash out?  Yes No

Amount of cash out refinance

Are any of these loans a Home Equity Line of Credit?  Yes No

If so, amount of Home Equity Line of Credit

Any of the funds used to improve the property?  Yes No

If so, amount of total improvements