Is the mortgage you are having problems with your primary residence?:--None--Yes No
Have you missed any mortgage payments?:--None--Yes No
Do you anticipate having difficulties making your mortgage payments moving forward?:--None--Yes No
Do you believe that the amount you owe on your mortgage(s) is greater than the current value of your home?:--None--Yes No
Have you received a foreclosure notice (Notice of Default or Lis Pendens) from your lender?:--None--Yes No
Are you considering or currently in bankruptcy?:--None--Yes No
Have you attempted to work with your mortgage company to resolve your situation?:--None--Yes No
Have you attempted to refinance or modify your loan and been denied?:--None--Yes No
I am a:--None--Home Owner Renter


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