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Client Info
Inc & Exp
Subject Property Details
Subject Address
Subject City
Subject State
Subject County
Subject Zip Code
Subject Property
Subject Present Occupancy
Subject Property Type
What is the home value?(As-Is)  $
Borrower Contact Info
Borrower's first name
Borrower's last name
Borrower Email
Phone Number
 -    -  
ALT Phone Number  -    -   Ext #  
Cell Number  -    -  
Fax  -    -  
Marital Status?  Single  Married  Divorced  Widowed
Date Of Birth

SSN Number
 -    -  
Time Zone
Cell Carrier
Work Number  -    -   Ext #
International Number
Best time to contact?
Preferred method of contact
Business Entity
Yes No

Borrower's Mailing Address
Same as Property Address?

Zip Code
Borrower's Previous Address
Previous Mailing address on the last tax
return filed if different from mailing address

Zip Code
Length of time at the property
Borrower Background
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Is there a Non-Borrower Contributor?

Is there a Co-borrower?
1st Lien Current Mortgage Scenario
Loan Type Terms Rate % Current Unpaid
Principal Balance $
Original Loan Amt $ Loan Number Notice of Acceleration

    Months Behind (Manual Entry) Last Payment Made Days Behind

Original Lender Current Lender/Servicer Mortgage Type Mortgage Investor/Owner
Monthly P + I Payment $ Monthly Taxes $ Monthly Property
Insurance $
Insurance $
Priv. Monthly
Mortg. Insurance $
H.O.A Fees $
  =  Total Monthly Payment
Past Due
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
Last Payment Made

Current Lender/Servicer Months Behind (Manual Entry) Days Behind (Based on last payment date)
Original Lender Mortgage Type Mortgage Investor/Owner
HMDA - (Borrower)
Yes No NA
Hispanic or Latino Not Hispanic or Latino
 American Indian  Asian
 Black or African American
 Native Hawaiian or Other Pacific Islander
Male Female
Client Notes PrintFriendly