Short Sale Qualification Survey
PROPERTY INFORMATION
Street Address
*
City
*
State
Zip Code
*
Property Condition
Please Select
Excellent
Good
Fair
Needs minor repair
Needs major repair
Originally Purchased As
Please Select
Primary Residence
Investment
Current Occupancy Status
Please Select
Owner Occupied
Tenant Occupied
Vacant
Is tenant current on rent payments?
Yes
No
How much is monthly rent?
When does current lease end?
-
Month
-
Day
Year
Date
When did you move out?
-
Month
-
Day
Year
Date
Repairs Needed
Is there a Condo or Homeowner Association?
*
Yes
No
Not Sure
Are you current on your dues?
*
Yes
No
Not Sure
Estimated HOA/ COA balance
When was the last payment made?
-
Month
-
Day
Year
Date
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OWNER INFORMATION
Number of owners
*
Please Select
1
2
3
Owner #1 Full Name (As appears on Mortgage)
*
On the mortgage?
*
Yes
No
Do you have security clearance?
Yes
No
Do you reside at the property?
*
Yes
No
Full Mailing Address
Phone
*
E-mail
*
Employment Status (please check all that apply)
*
Employed Full-Time
Employed Part-Time
Self-Employed
Retired
Unemployed
Approximate MONTHLY Gross Income (all sources above)
*
Approximate MONTHLY Net Income (all sources above)
*
Do your current liquid, non-retirement assets (checking, savings, stocks, bonds accounts, etc) exceed $10,000
*
Yes
No
Owner #2 Full Name (As appears on Mortgage)
*
On the mortgage?
*
Yes
No
Do you have security clearance?
Yes
No
Do you reside at the property?
*
Yes
No
Full Mailing Address
Phone
*
E-mail
*
Employment Status (please check all that apply)
Employed Full-Time
Employed Part-Time
Self-Employed
Retired
Unemployed
Approximate MONTHLY Gross Income (all sources)
Approximate MONTHLY Net Income (all sources)
Do your current liquid, non-retirement assets (checking, savings, stocks, etc) exceed $10,000
*
Yes
No
Owner #3 Full Name (As appears on Mortgage)
*
On the mortgage?
*
Yes
No
Do you have security clearance?
Yes
No
Do you reside at the property?
*
Yes
No
Full Mailing Address
Phone
E-mail
Employment Status (please check all that apply)
*
Employed Full-Time
Employed Part-Time
Self-Employed
Retired
Unemployed
Approximate MONTHLY Gross Income (all sources)
*
Approximate MONTHLY Net Income (all sources)
*
Do your current liquid, non-retirement assets (checking, savings, stocks, bonds accounts, etc) exceed $10,000
*
Yes
No
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HARDSHIP INFORMATION
Cause of Financial Hardship (please check all that apply)
*
Unemployment
Divorce/Separation
Reduced Income
Increased Expenses
Loss of Tenant
Death In The Family
Job Relocation
Mortgage Payment Adjustment
Other
Please provide a brief statement explaining your hardship
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MORTGAGE INFORMATION
Number of Mortgages
*
Please Select
1
2
3
1st Mortgage Lender
*
Type of Loan
*
Please Select
Conventional
FHA
VA
CDA
Home Equity Line of Credit
Not Sure
MONTHLY mortgage pmt
*
Approximate Loan Balance
Are you current on this loan?
*
Yes
No
When was last payment made?
-
Month
-
Day
Year
Date Picker Icon
2nd Mortgage Lender
*
Type of Loan
*
Please Select
Conventional
FHA
VA
CDA
Home Equity Line of Credit
Not Sure
MONTHLY mortgage pmt
*
Approximate Balance
Are you current on this loan?
*
Yes
No
When was last payment made?
-
Month
-
Day
Year
Date Picker Icon
3rd Mortgage Lender
*
Type of Loan
*
Please Select
Conventional
FHA
VA
CDA
Home Equity Line of Credit
Not Sure
MONTHLY mortgage pmt
*
Approximate Balance
Are you current on this loan?
*
Yes
No
When was last payment made?
Did you receive Notice of Intent To Foreclose from your lender?
*
Yes
No
Not Sure
When?
-
Month
-
Day
Year
Date
Did you receive Notice of Default from your lender?
*
Yes
No
Not Sure
When?
-
Month
-
Day
Year
Date
Name of Foreclosure Attorney
Did you receive Foreclosure Auction Notice?
*
Yes
No
Not Sure
Scheduled Auction Date
-
Month
-
Day
Year
Date
Name of Auctioneer
Have you filed for Bankruptcy since you have owned this property?
*
Yes
No
Type
*
Chapter 7
Chapter 13
Not Sure
Date Filed
-
Month
-
Day
Year
Date
Was it discharged?
*
Yes
No
Not Sure
Date discharged
-
Month
-
Day
Year
Date
Are you considering filing for Bankruptcy
*
Yes
No
Not Sure
Submit
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