Lexington Office: 21 W. 2nd St. Lexington, NC 27292
Office Phone# (336) 236-1675
Email: miriam@hsdcnc.org
Foreclosure Prevention or Loan Modification Intake
Client/Account Information
By providing us with the information below, you are authorizing HSDCNC to use the information for purposes of contacting lenders/mortgage companies in reference to your loan(s), for researching solutions and possible other agency referrals. All information is kept private except for when HSDCNC is speaking upon your behalf to work with lenders/mortgage companies and referral partners that may further assist your needs.
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Full Name
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First Name, Middle Initial, Last Name
Phone Number
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ex. (336) 123-4567
Email
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example@example.com
Preferred Language
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English, Espanol, etc.,
Please answer the following questions, if unsure then please type 'help':
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If you are behind on loan/mortgage payments then how many months are you behind?
Please provide us with detailed lender/mortgage company contact information. Include name, address and telephone #.
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Please provide us with detailed information about how you arrived at this situation.
If you need help with this then we can assist you!
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That's it for now! Just hit submit below if you are finished or save to continue later. Thank you for contacting us regarding your foreclosure prevention or loan modification needs. Your information will be reviewed as soon as possible and you should receive a response within 3-5 business days. If you need further assistance then please call our office Monday-Friday between 9:00am-5:00pm at 336-236-1675.
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Counselor signature:
HSDCNC Counselor Signature
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