Section 1: Client Identity

Full Legal Name

Other names used in the last 8 years

Date of Birth

Month

Day

Year

Social Security Number

Phone

Email

Marital Status

Spouse Full Legal Name

How many dependents and their ages

Section 2: Property Information

Basic Identification

Property Address

County

APN/Parcel Number

Property type

Year Built

Square footage

Bedrooms

Bathroom

Upload the following photos of your home: 1- street view, 2- entry way, 3- kitchen, 4- great room/family room, 5- each bathroom, 6- each bedroom, 7- backyard/patio; 8- any other area pertinent for valuation

Ownership & Title

List all individuals/entities currently on title

Physical Condition & Improvements

Physical condition of the property

Structural & Systems Checklist (Check all that apply)

Brief explanation of major issues

Occupancy & Use

Is this your primary residence?

How long have you lived here?

If you do not live here, who does?

Monthly rental income (if any)

List the full names of all individuals currently living at the property

Taxes, HOA & Municipal

Are property taxes delinquent?

Property Tax Balance

Full name of HOA (if there is a Master HOA and Sub HOA, please list both)

Contact information for each HOA management company

HOA monthly assessment- Primary/Master HOA

HOA monthly assessment- Sub HOA

Are there any recent or active HOA delinquencies, collections, violations, foreclosures, and lawsuits involving the property?

Describe all recent and active HOA delinquencies, collections, violations, foreclosures, and lawsuits involving the property

Section 3: Mortgage Information & Foreclosure Status

Lender/servicer names and contact information

Trustee name and contract information

Loan Number

Original Loan Amount

Current loan balance/payoff amount

Monthly payment

Interest rate

Arrears amount

Date of last payment

Month

Day

Year

List the date and manner that you received each document

Please list any other mortgages, liens, or judgments recorded against the property

Section 4: Income & Employment

Employer Name

Job Title

Length of Employment

Gross monthly income (i.e., money earned before deductions)

Spouse's income (if applicable)

Other income sources (list source and gross monthly amount)

Section 5: Monthly Expenses

For each category, provide your best, good-faith estimate of how much you spend per month

Housing cost (e.g., mortgage)

Utilities

Food

Transportation (e.g. vehicle payments, gas, maintenance, registration)

Insurance

Childcare

Medical (e.g., medications, appointments, past bills)

Personal and household supplies, entertainment, subscriptions, etc.

Section 6: Assets

List all assets that you own and the estimated value of each asset (e.g. financial accounts- bank, investment, stocks, retirement, and crypto. Also include any real estate, vehicles, equipment, valuables, etc.)

Section 7: Debts

List all debts that you owe

Section 8: Legal History

Have you ever filed bankruptcy?

List all prior bankruptcies (Chapter and year), pending lawsuits, judgments, wage garnishments, bank levies, foreclosure procedures, short sale attempts, and prior loan modification attempts. Include the date and outcome of each proceeding.

Section 9: Client Goals and Expectations

What is your greatest and most pressing concern right now?

What is your primary goal(s)

Save my home (e.g., modify loan, refinance, or payoff arrears)

Remain in my home for as long as possible while I stabilize my financial situation

Preserve my credit score, sell home, and maximize equity

Get a fresh start in life and walk away clean

Stop creditors from harassing me

Strategic default- i.e., I can't keep up with payments and need to find the best way out

I believe my lender is not following the law or is treating me unfairly

Any or all of the above

I don't know right now

If keeping your home long term were not possible, would you be willing to sell and move?

How important is it that your children remain in the same school or school district? (if applicable)

Do you currently have any alternative living arrangements available?

How much do you think you realistically can afford to pay towards housing each month given your current circumstances?

What would a successful outcome look like to you one year from now?