LMR Data Form
Please select the loan
advocate or referral source
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All File Types Branch
DIY Software
Frederick Albright
melissa vardas
REST Test Branc
or
Useful Documents
Fillable Application in PDF
Fillable Application PDF- Spanish Version
Basic Info
Homeowner First Name
Homeowner Last Name
Co-owner First Name
Co-owner Last Name
File Type
Biz Funding
Business Funding
Commercial/Residential Real Estate
Conventional/Agency
Equipment Financing
Loan Mod/Foreclosure Defense
Loan Origination
Short Sale
Which services are requested?
Jumbo
Commercial
Blanket/Portfolio Loan
Bridge Loan
Commercial
New Construction
Cash Out Refi
Fix and Flip
Joint Venture Rehab
Land
Long Term Rental Loan
Transactional Funding
Bankruptcy
Bankruptcy Ch 7
Bankruptcy Ch 13
Deed in Lieu
Forensic Audit
Foreclosure Defense
HAMP Modification
HOME Report
2nd Lien Modification
Loan Modification
Loss Mitigation
Securitized Audit
Trial Mod
Asset Based Line of Credit
Unsecured Line of Credit
Equipment
Franchise Financing
Merchant Cash Advance- MCA
SBA-7a
Working Capital
Unsecured Term Loan
HAFA Short Sale
Short Sale
How did you hear about us?
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Direct Mail
Direct Sales Call
Google
Radio Ad
Referral
TV Commercial Ad
Phone number
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Ext #
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Cell number
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Email
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Property Info
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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separater
Single Family Home
Condo
Condo Low Rise
Condo High Rise
Loft
TownHouse
SRO
Manufactured
Duplex
3 Units
4 Units
Multi-Family
Multi-Family-2
Multi-Family-3
Multi-Family-4
Lot/Land
separater
Apartment Complex
Assisted Living Facility
Auto Repair
Church
Co-Op
Commercial Lot/Land
Condotel
Construction
Daycare
Developed Land
Funeral Homes
Garage/Storage
Hotel
Light Industrial
Mixed Use
Motel
Multi-Family-5+
Mobile Home Park
Medical Office
New Residential Development
Owner Occupied Business
Office Building
PUD
Retail
Restaurant/Bar
Resorts
Special Purpose Properties
Self-Storage
Strip Mall
Recreational Properties
Tavern
Warehouse
Other
What is the current estimated value of your home?
Get Zillow Value
How many years have you lived in the property?
Do you want to stay in this home?
Hardships
Housing Payment Increase
Death of a significant other
Death of a family member
Damage to Property
Divorce
Separation
Military Service
Business Failure
Reduced Income
Illness
Medical Bills
Job Relocation
Unemployment
Incarceration
Too Much Debt
Other (Please Specify)
Negative Equity
Disaster
Low Cash Reserves
Mortgage Info
Who is your 1st mortgage lender?
What is the estimated balance for the 1st mortgage?
What was the original amount of the 1st mortgage?
What is the payment of the 1st mortgage?
What is your monthly property tax payment?
What is your monthly property insurance payment?
Is there a 2nd lender?
Who is your 2nd mortgage lender?
What is the estimated balance for the 2nd mortgage?
What was the original amount of the 2nd mortgage?
What is the payment of the 2nd mortgage?
Is the mortgage currently behind?
How many months behind?
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0
Imminent Default
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36+
Have you received a notice of foreclosure?
Enter Sales Date if provided
by bank/attorney/trustee
Have you already received or tried to receive
a modification/ forbearance/work out from your bank?
if yes... Please provide all details
Mortgage Notes
