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Contact Name

Phone

Email

The Following Information will be helpful to us.

*Street Address*
*City, State, Zip*

Has Foreclosure Already Started?

YesNoNot Sure

Briefly Explain Your Situation.

What do you think is your best course of action?

Is there anyone else involved with you in the foreclosure?

YesNo

What is the name and relationship of the other people involved?

*When was foreclosure filed?*
*When is the Foreclosure Sale Date scheduled?*
*How many months' payments are owed on the mortgages?*
*Are you living at the property?*	YesNo
*Is the property rented?*	YesNo
*Do you need counseling about your foreclosure?*	YesNo
*Do you want to be contacted by a mortgage lender to see if he/she can help you get a new loan?*	YesNo
*Do you want assistance in filing bankruptcy?*	YesNo
*Do you only want information about filing bankruptcy?*	YesNo
*Do you want to sell your property?*	YesNo

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