Delivery of this form is either in response to your recent inquiry regarding a temporary or modified payment plan or our efforts to address your current financial hardship and the overdue amount mortgage with us. To provide you with resolution alternatives, please complete this entire form along with the requested supporting documentation. No package will be processed until ALL items requested are received.

Before you begin to complete this form you should have on hand:

• Your latest W-2 
• The last two pay statements from your employer(s)
• If self-employed, the cover page of your last tax return and last two months of bank statements from your primary payment checking or savings account
• Auto Loan balances and monthly payment amount
• Credit Card balances and monthly payment amount
• Student Loan balances and monthly payment amount
• A calculator will also be helpful

These documents can be scanned or photographed for upload later in the form.

If any fields do not apply to you, you may leave them blank.

I / We hereby authorize you to release to Creative Note Solutions or its agents and assigns, any, and all information or documentation that may be requested about the above-referenced loan/account or the above referenced property. "Agents” shall include, but not be limited to, all real estate agents, attorneys, their assistants, and junior lien holders. A copy of this authorization may be accepted as an original.

Please take a moment to complete the following financial statement so we may better understand your circumstances and tailor a custom solution to meet your needs. We require information related to your monthly income and expenses. If there are additional contributors to your household income OR if additional parties are financially responsible for this lien, please include this information below as well.  If there are questions that do not apply to you, leave the information blank.

I/We confirm and acknowledge that the information presented herein is true and accurate to my/our knowledge.

I am advised here that submission of this information is not a guarantee that a payment plan of any kind, will be approved.  The documentation I provided will be reviewed and verified. This process may take 5-7 business days. It is important that I can be reached during this timeframe to address any questions (if any) which may develop during this review process. I understand that it important to supply this information immediately, as Creative Note Solutions will agree to suspend any further action(s) for the next ten (10) days only, thereby allowing you ample time to respond.

THIS IS AN ATTEMPT TO COLLECT FINACIAL INFORMATION FROM THE HOMOWNER(S), IN REFERENCE TO THE MORTGAGE / DEED OF TRUST LIEN, SECURED AGAINST THE PROPERTY.    ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.   In the event you have received a Chapter 7 Bankruptcy Discharge, please be advised that this Loss Mitigation Request solely relates to the Mortgage / Deed of Trust Lien, Secured Against the Property.   This Loss Mitigation Package Request shall not in one way be construed as an attempt to collect a personal debt from you or in any way to bind you personally liable for the debt.  This Loss Mitigation Package Request shall not be considered a reaffirmation Agreement, as that term is defined by applicable bankruptcy law.  This Loss Mitigation Package Request is a required request by the Company, so the Company can put the Homeowner(s) in the best possible payment terms on the Mortgage / Deed of Trust Lien, Secured Against the Property.