LMR Data Form
Please select the loan
advocate or referral source
- Select / New -
DIY Software
Foreclosure Def
Frederick Albright
melissa vardas
REST Test Branc
or
Useful Documents
Fillable Application in PDF
Fillable Application PDF- Spanish Version
Basic Info
Information
Borrower Information
First Name
Last Name
File Type
Asset Management
Loan Mod/Foreclosure Defense
Short Sale
Which services are requested?
Acquisition
Loan Modification
Short Sale
How did you hear about us?
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Google
Radio Ad
TV Commercial Ad
Direct Mail
Direct Sales Call
Referral
Is there a Co-Applicant?
Co-owner First Name
Co-owner Last Name
Phone number
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-
Ext #
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Cell number
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Email
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Property Information
Property Address
Property City
Property State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
County
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Property Zip
Property Type
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Single Family Home
Duplex
3 Units
4 Units
Apartment Complexes
Auto Repair
Condo
Condo Low Rise
Condo High Rise
Condotel
Construction
Co-Op
Developed Land
Daycare
Funeral Homes
Garage/Storage
Hotel
Light Industrial
Lot/Land
Loft
Manufactured
Mixed Use
Motel
Mobile Home Park
Multi Family
Medical Office
New Residential Development
Owner Occupied Business
Office Building
PUD
Retail
Restaurant/Bar
Resorts
Special Purpose Properties
SBA/Working Capital
Self-Storage
Strip Mall
Recreational Properties
Tavern
TownHouse
Warehouse
Other
Estimated value of your home? (
Enter Lowest
Value From Look-up Link)
Get Appraisal Value
Mortgage Information
Who is your 1st mortgage lender?
How many months are you behind?
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0
Imminent Default
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
36+
What is the estimated balance for
your 1st mortgage?
What is the payment of your 1st mortgage?
What is your monthly property tax payment?
What is your monthly property insurance payment?
Do you have a 2nd lender?
Who is your 2nd mortgage lender?
How many months are you behind?
- Select -
0
Imminent Default
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
36+
What is the estimated balance for your 2nd mortgage?
What is the payment of your 2nd mortgage?
Income and Expenses
Primary Borrower
Co-borrower
Occupation?
Employment Type
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Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
Occupation?
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
Employer Information
Employer Name
Years at job
Employer Name
Years at job
Gross Monthly Income? $
Net Monthly Income $
Gross Monthly Income? $
Net Monthly Income $
Social Security $
(Income Monthly)
Pension/Retirement $
(Income Monthly)
Social Security $
(Income Monthly)
Pension/Retirement $
(Income Monthly)
Disability $
(Income Monthly)
Child Support/Alimony $
(Income Monthly)
Disability $
(Income Monthly)
Child Support/Alimony $
(Income Monthly)
Room Rental $
(Income Monthly)
Monthly Income (2nd Job) $
(Monthly)
Room Rental $
(Income Monthly)
Monthly Income (2nd Job) $
(Monthly)
Unemployment $
(Income Monthly)
Other $
(Income Monthly)
Unemployment $
(Income Monthly)
Other $
(INCOME MONTHLY)
Monthly Expenses
PRIMARY BORROWER
CO BORROWER
Credit Cards $
(Monthly)
Total Credit Card
Balance(s)
$
Credit Cards $
(Monthly)
Total Credit Card
Balance(s)
$
Auto Loan(s) $
(Monthly)
Total Auto Loan
Balance(s)
$
Auto Loan(s) $
(Monthly)
Total Auto Loan
Balance(s)
$
Unsecured Loan(s) $
(Monthly)
Total Unsecured Loan
Balance(s)
$
Unsecured Loan(s) $
(Monthly)
Total Unsecured Loan
Balance(s)
$
Student Loans/Tuition $
(Monthly)
Total Student Loan
Balance(s)
$
Student Loans/Tuition $
(Monthly)
Total Student Loan
Balance(s)
$
Alimony/Child Support $
(Monthly)
Child/Dependent/Elderly Care $
(Monthly)
Alimony/Child Support $
(Monthly)
Child/Dependent/Elderly Care $
(Monthly)
Insurance (Auto, health, life) $
(Monthly)
Groceries $
(Monthly)
Insurance (Auto, health, life) $
(Monthly)
Groceries $
(Monthly)
Car Expenses (gas, maint.) $
(Monthly)
Doctor/Medical Bills $
(Monthly)
Car Expenses (gas, maint.) $
(Monthly)
Doctor/Medical Bills $
(Monthly)
Entertainment $
(Monthly)
Other $
(Monthly)
Entertainment $
(Monthly)
Other $
(Monthly)
Utilities
Primary Borrower
Co-borrower
Cable TV/Satellite $
(Monthly)
Electricity $
(Monthly)
Cable TV/Satellite $
(Monthly)
Electricity $
(Monthly)
Natural Gas/Oil $
(Monthly)
Telephone/Cell $
(Monthly)
Natural Gas/Oil $
(Monthly)
Telephone/Cell $
(Monthly)
Water/Sewer $
(Monthly)
Internet $
(Monthly)
Water/Sewer $
(Monthly)
Internet $
(Monthly)
Other $
(Monthly)
Other $
(Monthly)
Household Expenses notes
