Foreclosure Prevention Counseling Form

All information is kept confidential. We will not share it with other organizations.

Complete the form below and a HUD approved Housing Counselor will call you within 48 business hours to help you avoid foreclosure and protect the equity in your home.

Enter information below then click the submit button.

Personal Information

First Name:
Last Name:
Email:
Daytime Phone:
Alternate Phone:
Best Time To Call:

Property Information

Street Address:
City:
State:	Washington
Zip:

Foreclosure Information

Type of Mortgage (conventional, FHA, VA, jumbo):
1st Mortgage Company Name:
How many months behind are you:
What is the total amount of back payments:
Have you received a foreclosure notice:	Yes     No
Is there an auction date set:	Yes     No
What is the date:
2nd Mortgage Company Name:
Combined balance on all mortgages:
Combined payment on all mortgages:
Are you currently in bankruptcy:	Yes     No

Your Situation

So we can better help you, please give us an idea of your situation:
Ultimately, do you want to:	Keep the property or Sell the property
How did you hear about us: