Residential Loan Modification Preliminary Worksheet Basic Information Name Address Phone Number Email Best Time to Contact Before After Preferred Contact Email Phone Property and Loan Information Property Type Please Choose One Single Family Duplex Townhome Condominium Multi-Unit Loan Type Please Choose One Fixed Adjustable Loan Term Please Choose One 15 Year 30 Year Other Interest Rate Property Value Amount Owed Mortgage Payment Including Taxes and Insurance? Yes Your Situation Are you currently behind on your Mortgage payment? Have you received a foreclosure notice? Have you completed a Loan Modification in the last 12 months? Past due Amount Owed (Including late fees) How many months behind are you? Please review that all information is accurate before submitting. Your information is confidential and will not be sold to any third-party companies.