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Complete the following form so that we may review your situation and begin working on your application. Please try and complete the form with all the information requested. If you do not have the information handy, you may update us with the missing information by using the "Contact Us" form on our website.

Full Name (required) *

Phone Number (required) *

Email Address (required) *

Property Address (required) *

City, Province, Postal Code (required) *

Preferred Contact Method(s) *

Phone
Email
Text

Best Time to Contact *

Morning (8:00 am to 12:00 pm)
Afternoon (12:00 pm to 5:00 pm)
Evening (5:00 pm to 10:00 pm)

Property Type: *

Single Family Detached House - Urban
Single Family Detached House - Rural
Condominium (apartment, townhouse, duplex WITH condo fees)
Townhouse or Duplex (NO condo fees)
Multi-Family
Agricultural (farm)
Other

Current Market Value (estimate) *

Purchase Price *

Purchase Date (month/year) *

Do you currently live in this property? *

Yes
No - it's a rental property
No - it's vacant
No - other

Current Mortgage Lender(s) *

Original Mortgage Amount *

Current Mortgage Balance *

Monthly Mortgage Payment *

Are you currently behind on payments? *

Yes
No

If yes, how many months behind?

Have you received a foreclosure notice? *

Yes
No

Where are you in the process? *

We've only received a demand letter for payment
Foreclosure proceedings have started
We have a date for a Redemption Order
A Redemption Order has been granted
A Judicial Sale Order has been granted
The property is listed on MLS® with a REALTOR® by Court Order
Other
I don't know

Are there any other liens or debts against the property? *

Yes
No

If yes, please describe:

Current household monthly income from all sources *

Why are you facing foreclosure? *

Job Loss
Medical Situation
Relationship Breakdown
Business Failure
Other

What is your ideal outcome? *

Stay in home and catch up on payments
Sell property and avoid foreclosure
Other

How long do you need to resolve your financial situation? *

3-6 months
6-12 months
12+ months
Unsure

Are you working with a real estate agent? *

Yes
No

Are you working with a lawyer? *

Yes
No

How did you hear about our program? *

Is there anything else we should know about your situation? *

Consent and Next Steps - I authorize [Your Company Name] to review my information and contact me regarding foreclosure relief options *

Yes
No

I understand this is not a loan application and there is no obligation *

Yes
No

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