4M Capital

Foreclosure Prevention

Client Application

The info you submit is held in complete confidence and not shared with third parties. Also, the information below IS NOT shared directly with your lender! It is used initially for internal purposes only.

NOTE:
(1) an asterisk ( * ) indicates a required field.
(2) You may complete application online and submit online
(3) You may print application, complete application and mail or fax
to address below.

Mail or Fax Printed Application to:

Default Resolution Group
Application Processing
955 SW Baya DR
Lake City, FL. 32025

Fax 386-754-5094

General Information

* First Name		First Name
* Last Name		Last Name
* Address		* City
* Home Phone		State
Best Time to Call		* Zip
Fax Number		Referred By
* Email		* Confirm Email

Property & Mortgage Information

Approximate Price Paid for Property	$
* How long have you lived there?

The Area Around Property is: Upper Class Upper Middle Class Working Class Where Pride of Ownership Shows Some Homes Need Work Many Homes Need Work I'm Not Sure

Approximate Home Square Footage: $

The Condition of the Property is:

Well Kept (Landscaped, Manicured lawn)
Average (Needs no Repair)
Average (Needs some Repair)
Needs Major Renovation
Vandal Damaged
Complete Tear-Down Needed
Complete Loss- Fire
Complete Loss- Storm
Vacant Land
Other

Which Mortgage is in Default :

First Second Third First & Second Second & Third All

* 1st Mortgage Lender Name
*1 st Mortgage Lender Phone
Date of Last Payment
* Payment Amount	$
Default Notice Date
* Approximate Amount in Arrears	$
* 2 nd Mortgage Lender Name
*2 nd Mortgage Lender Phone
Date of Last Payment
* Payment Amount	$
Default Notice Date
* Approximate Amount in Arrears	$
Estimated Value of Property	$
Sale Date Set for Default

Details

Specify the approximate number of attempts you have made to resolve matters, between you and your lender
Has the lender refused to accept or returned, any money that is now claimed to be in arrears (that you owe)?	Yes No
Of the total amount in arrears, have you saved any of that money ?	Yes No
To the best of your knowledge, was your loan transferred to another lender AFTER you fell behind in payments?	Yes No I Don't Know

* On a scale from 1 to 10, specify your level of commitment to Saving Your Property threatened by the default or foreclosure ( 1 being slightly committed and 10 being totally committed):

1 2 3 4 5 6 7 8 9 10

Have you had any difficulty contacting your lender?

Yes
No

Using the space below, please briefly describe any trouble you've had contacting your lender to resolve the default or foreclosure

Which situation best fits how you got behind on your mortgage?

I Lost My Job My Spouse Lost Job My Spouse and I Lost Job Temporary Lay-off Reduction in Hours Illness/Injury Expensive repairs Too many other Bills Divorce/Separation Death of a Loved One A Drug Problem Other

Please briefly describe the events that caused you to fall behind in your Mortgage payments ( 100 words or less):

If we take on your case, will you follow our instructions and recommendations to resolve your default ?	Yes No
Aside from us, how many other firms have you contacted about helping resolve your mortgage default?

Please select the statement that best fits how you would like to resolve your mortgage troubles.

I want to Save My Home!

I would Sell My home if I could get some Cash!

I want a Loan to Consolidate my Bills!

I would just like to File Bankruptcy!

I am Not Sure Right Now!

None of these Apply!

Have you been considering bankruptcy to solve the mortgage default

Yes
No

Have you ever declared Bankruptcy? Yes No

If so, was it completed? Yes No

Date of Discharge:

Do you understand that we do not advocate bankruptcy, as a first line or primary defense ?

Yes
No

Please indicate the total amount of all the mortgages on the property, in or threatened by foreclosure .

To the best of you knowledge, which type of mortgage is in Default:

Conventional Government (FHA, VA, Etc.)

Private Lender

I'm Not Sure

Other

How much money does the Mortgage Company say is due to get your mortgage current?

How much Money do You have available to go to the Mortgage Company right Now?

If your Mortgage Company would require you to make a house payment as good faith, how long would it take for you to have one available?

Type of Service Offered by Default Resolution Group, in which you are interested
Premium Plan Service
Basic Plan Service
Referral Plan Service

If we can find a way to get you caught up on your mortgage, do you promise to make paying of your mortgage your highest priority? Yes No

Would you like to become one of our clients?

Yes
No

So that we may accurately focus on those needing default mortgage help, please let us know how you heard about Default Resolution Group.

Your Comments
Please elaborate on any issue pertaining to your particular situation or about the above questions.

I hereby attest that all items are accurate and true. I authorize the release of all information contained on this web page to 4M Capital, Inc (Default Resolution Group).

First Name: MI: Last Name:

Date:

Your E-Mail address:

Default Resolution Group

Form CA 0203-01