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Foreclosure Prevention Services Request
Please fill out this form below and a Foreclosure Prevention Specialist from Home HeadQuarters will contact you as soon as possible.
Default/Foreclosure Issue:
Mortgage Arrears
Delinquent Property Taxes
Other
If Other, please explain:
Name
*
First Name
Last Name
Address
*
Is this your primary residence?
*
Yes
No
Phone Number
*
Email Address
*
How Many People in Your Household?
Estimated Household Income?
Military Status
*
Active Military
Military Reserve
Veteran
NA
Servicer/Mortgage Company:
*
Type of loan:
*
FHA
VA
USDA
Fannie Mae
Freddie Mac
Convention
HELOC
Don't Know
How many months are you behind in payment?
Less than One Month
1 Month
2-3 Months
4-6 Months
6-11 Months
One Year
More than One Year
Date of last payment?
Have you been served?
Yes
No
Don't Know
If yes, when were you served?
Do you have a Settlement Conference Date?
Yes
No
Are property taxes included in your mortgage?
Yes
No
Are your property taxes current?
*
Yes
No
If no, how much is owed?
Is homeowner's insurance included in the mortgage?
*
Yes
No
Is there anything else you would like to tell us?
Thank you! A Foreclosure Prevention Counselor will contact you as soon as possible.
