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National Short Sale Evaluation Form

First Name *
Last Name *
Phone *
Email *
Address *
City *
State/Region *
Zip/Postal Code *
Is this your primary residence? *	Yes No
Explanation of Financial Hardship:
Months Behind *
Purchase Price *
Year Purchased *
1st Mortgage Servicer/bank *
Payoff or Balance on 1st loan
2nd Mortgage Servicer
Payoff or Balance 2nd loan
Payoff or Balance of other loans
Has a notice of default/trustee sale been posted? *
Today’s Approximate Market Value
Have you ever refinanced to cash out? *	Yes No
Amount of cash out refinance
Any of these loans a Home Equity Line of Credit? *	Yes No
Amount of Home Equity Line of Credit
Any of the funds used to improve the property?	Yes No
Amount of total improvements
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