Referral Info Sheet

We appreciate that you have decided to take a few moments to answer the below questions. Please verify all questions are answered to the best of your ability and then click “Send” at the bottom of the page when completed. We will contact you within 24 hours to go over the available options with you and your client/referral. Together we will determine which Solution works best for them and their family.

Please fill out this form including your client's information.

Referring Realtor

Your Company

Your Phone

Your Email

Best Way To Contact You
 Phone Email Either

Best Time To Contact You
 Morning Afternoon Evening Anytime Weekday Weekend

Property Street Address

Property City and State

Property Zip Code

Type Of Property
 Single Family Condo or Townhome Duplex Multi-Family Commercial

Property Details
 1 Bedroom Two Bedroom Three Bedroom Four Bedroom Five Bedroom 1 Bath Two Bath Two and Half Bath Three Bath

Square Footage of House

How Many Months Is Your Client Behind On Payments?

Have They Filed Bankruptcy?
 Yes No Thought About It

If You Answered Yes Above, Please Enter Year
 2002 2003 2004 2005 2006 2007 2008 2009 2010

Are They Currently Employed?
 yes no laid-off disabled retired

Primary Lender And Loan Balance

*HELOC Or Second Note On Property
 yes no

Name Of Second Lender And Loan Balance

Are There Any Other Liens On The Property? If So, Please List The Name Of The Lien Holder(s) and Approximate Balance of Lien

How Did You Find Out About Us

Anything Else You Believe We Should Know?