Create Loss Mitigation file

denotes Mandatory

Property Management

Contact Person		Property Management Company
Email		Address
City		State	Zip
Phone	- - Ext #	Notes

HOA Information

Does the borrower pay a Condominium or HOA fee?

Is there a Master/Secondary HOA/COA?

Full Property Address

Address
City
State
County
Zip Code

Subject Property

Occupancy
Property Type
Are taxes escrowed?
Is Insurance escrowed?
What is the home value? $	Get Appraisal Value

Borrower Contact Info

Borrower's first name

Borrower's last name

Borrower Email

Phone Number

- - Ext #

ALT Phone Number

- - Ext #

Cell Number

- -

Fax

- -

Marital Status?

Single Married Divorced Widowed

Date Of Birth

(MM/DD/YYYY)

SSN Number

- -

Time Zone

Please select service provider
if you would like to receive
task reminders via SMS

Work Number

- - Ext #

International Number

Best time to contact?

Preferred method of contact

Borrower Present Address

Address
City
State
Zip Code
Same as Mailing Address?
Number of Years at Address ?
Has the borrower resided at the present address for less than two years?	Yes No
Property Type

Background

Are you a U.S. Citizen?	Yes No
Has the borrower been declared bankrupt within the past 7 years?	Yes No
(If Yes, Provide explanation below.)

Are there an outstanding judgements against the borrowers?	Yes No
(If Yes, Provide explanation below.)

Do you have any active lawsuits against you?	Yes No
(If Yes, Provide explanation below.)

Have you had or currently have any property tax liens?	Yes No
(If Yes, Provide explanation below.)

Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?	Yes No
(If Yes, Provide explanation below.)

Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee	Yes No
(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?	Yes No
(If Yes, Provide explanation below.)

Background Explanation

Business Entity

Are you borrowing under an Entity?	Yes No
Entity Name
Entity Type
EIN #
Address
City
State
Zip Code
State Of Formation
Website Address
Is the billing address the same as above?
Billing Address
Billing City
Billing State
Billing Zip Code

Members/Officers

(If borrower does not own 100% of entity, list additional members/officers)

Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership
Name	Title	% of Ownership

Borrower's Mailing Address

Same as Property Address?
Address
City
State
Zip Code
Property Type

Borrower's Previous Address

Previous Mailing address on the last tax return filed if different from mailing address
Address
City
State
Zip Code
Number of Years at Address ?
Property Type

Experience

Do you have flipping experience

Yes No NA

Do you have ground up construction experience?

Yes No NA

Do you have any projects currently in progress?

Yes No NA

Do you own investment properties?

Yes No NA

Are you a member of an investment club or group?

Yes No NA

Is there a Non-Borrower Contributor?

Non-Borrower Contributor

Is there a Co-borrower?

Co-borrower Information

First name First name
Last Name Last name
Email Email
Primary Phone Phone Number	- - Ext #
ALT Phone Number	- - Ext #
Cell Number	- -
Fax	- -
Date Of Birth	(MM/DD/YYYY)
SSN Number	- -
Credit Score Range
Experian Score
Equifax Score
Transunion Score
Years of School?
Time Zone
Please select service provider if you would like to receive task reminders via SMS
Work Number?	- - Ext #
International Number?
Best time to contact?
Preferred method of contact
# Of Dependents

Background

Are you a U.S. Citizen?	Yes No
Has the borrower been declared bankrupt within the past 7 years?	Yes No
(If Yes, Provide explanation below.)

Are there an outstanding judgements against the borrowers?	Yes No
(If Yes, Provide explanation below.)

Do you have any active lawsuits against you?	Yes No
(If Yes, Provide explanation below.)

Have you had or currently have any property tax liens?	Yes No
(If Yes, Provide explanation below.)

Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?	Yes No
(If Yes, Provide explanation below.)

Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee	Yes No
(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?	Yes No
(If Yes, Provide explanation below.)

Background Explanation

Co-borrower's Mailing Address

Co-borrower's Previous Address

Experience

Do you have any real estate investment flipping experience?

Yes No NA

Do you have ground up construction experience?

Yes No NA

Do you have any projects currently in progress?

Yes No NA

Do you own investment properties?

Yes No NA

Are you a member of an investment club or group?

Yes No NA

1st Lien Current Mortgage Scenario

Loan Type	Terms	Rate %	Current Unpaid Principal Balance $	Original Loan Amt $	Loan Number	Notice of Acceleration
						(MM/DD/YYYY)
		Months Behind (Manual Entry)	Last Payment Made	Days Behind
			(MM/DD/YYYY)
Original Lender		Current Lender/Servicer		Mortgage Type		Mortgage Investor/Owner

Monthly P + I Payment $	Monthly Taxes $	Monthly Property Insurance $	Flood Insurance $	Priv. Monthly Mortg. Insurance $	Monthly H.O.A Fees $	= Total Monthly Payment

Past Due Interest	Out of Pocket Escrow Adv $	Projected Escrow Adv during Trial $	Past Due Mtg. Ins $	Past Due H.O.A $	Late Fees (Not Included) $

2nd Lien Mortgage Scenario

2nd lien Loan Type	Terms	Rate %	Current Unpaid Balance $	Original Loan Amount $	Payment $	Loan Number	Past Due Interest	Last Payment Made
								(MM/DD/YYYY)
Current Lender/Servicer			Months Behind (Manual Entry)		Days Behind (Based on last payment date)

Original Lender			Mortgage Type	Mortgage Investor/Owner

Borrower

Co-Borrower

Personal Information

Do you own the majority of the business?	Yes No
Owner's Name
% Owned

Business Information

Business Name
Business Name (DBA)
Business Legal Name
Business Tax ID
Business Entity Type
Website
Industry
Are your clients businesses or consumers ?	Businesses Consumers

Financial Information

Q+A

Do you wish to furnish this information?	Yes No NA
What is your Ethnicity:	Hispanic or Latino Not Hispanic or Latino
What is your Race:	American Indian Asian Black or African American Native Hawaiian or Other Pacific Islander White
Sex:	Male Female

Do you wish to furnish this information?	Yes No NA
What is your Ethnicity:	Hispanic or Latino Not Hispanic or Latino
What is your Race:	American Indian Asian Black or African American Native Hawaiian or Other Pacific Islander White
Sex:	Male Female

Months in business?
Average monthly revenue ($)
Credit score
Annual Gross Revenue ($)
Monthly Bank Deposit Volume ($)
Average Daily Bank Balance ($)
Do you have invoices to factor?	Yes No
How much ($) ?
Requested Advance Amount ($)
Requested Term Length (in Months)
How do you plan to use your funding?
Does the business accept credit cards?	Yes No
Does the business have exsisting financing?	Yes No
On your most recent business tax return, did you show a net profit or a net loss?	Profit Loss
Amount?
Do you own collateral?	Yes No
Sum of monthly recurring debt payments

Credit Check Total Username		Credit Check Total Password
Experian Score		Equifax Score
Transunion Score		Monthly Income before Taxes?
Monthly Income after Taxes?		Are you employed?	Yes No
Can you prove income with paystub, W2, and income tax return?	Yes No	Number of Months at Current Job?
Have you or any family member served in the US Military?	Yes No	Do you own a business ?	Yes No
Type of Business		When did you incorporate?
Do you own or rent?	Own Rent	Credit Issues
Amount Desired?		Reason for Funds
Comments
Who Referred You?

Same as Borrower's Mailing Address? Same as borrower's mailing address?
Address
City
State
Zip Code
Property Type

or

Create Loss Mitigation file

Does the borrower pay a Condominium or HOA fee?

Is there a Master/Secondary HOA/COA?

Get Appraisal Value

Members/Officers

Information for Government Monitoring Purposes