Fraud Stoppers Intake Form



ATTENTION: Please do not open more than one case file using this form. If you have multiple properties you can add them to your case file from the "Property Info Page" after you log in.If you already have an open case file and you need to request additional services please call us.
Basic Info
Homeowner First Name
Homeowner Last Name
Co-owner First Name
Co-owner Last Name
File Type
Which services are requested?
Phone number
 -    -    Ext #
Cell number  -    -  
Email
Property Info
Property Address
Property City
Property State
County
Property Zip
Property Type
What is the current estimated value of your home?
 
How many years have you lived in the property?
Do you want to stay in this home?

Mortgage Info
Loan Origination Date

(MM/DD/YYYY)
Loan Origination Amount
Monthly Loan Payment
Original Lender
Current Lender/servicer
What is the estimated balance for the 1st mortgage?
Is there a 2nd lender?

Is the mortgage currently behind?

Have you received a notice of foreclosure?

Have you already received or tried to receive
a modification/ forbearance/work out from your bank?

Mortgage Notes