Your Specialist’s Name. Please check one:

    CLIENT INFORMATION:

    Name(s) as it appears on the Deed or Mortgage Document:

    Mailing Address:

    Client’s Email Address:

    Phone #:

    Cell #:

    Fax #:

    CLIENT INFORMATION:

    Full Property Address:

    County in which Property is located:

    Property Type: Residential or Commercial or Rental

    Enter type here:

    1. Current monthly mortgage payment amount: Amount:

    2. Are you currently in default? Yes or No
              Answer here:

    3. Have you received a notice of default or notice of intent? Yes or No
              Answer here:

    4. Total monthly household income, before taxes:

    5. Is there a sale/auction date? Yes or No
              Answer here:
              If yes, what is the sale/auction date?

    6. Has the property been sold? Yes or No
              Answer here:

    7. Have you or are you currently in any litigation(s) on the subject property? Yes or No
              Answer Here:

    8. Have you been served an eviction notice? Yes or No
              Answer here:

    9. Have you ever filed or currently in bankruptcy? Yes or No
              Answer here:

    10. Please tell us your story.

      • Include year situation started?

      • What happened? Illness, job loss, divorce, etc.?

      • Did you request a forbearance, what was the outcome?

      • Did you request a loan modification, what was the outcome?

      • Have you sought other professional assistance before coming to us?

    If you feel there are documents we should review, then click here to upload them.

    Upload Your Latest Mortgage Statement

    Upload the Most Recent Letter from Your Mortgage Company Attorney

    Consumer Advocates PMA Membership Agreement

    Consumer Advocates PMA has granted you a free temporary membership in the Consumer Advocates PMA Private Membership Association. This membership will allow Consumer Advocates PMA to complete and discuss with you the investigation you will request below. Temporary membership will expire when you move on to Step Three of our Four Step Plan. Articles of the PMA will be sent to you in pdf format via email.

    I authorize Consumer Advocates PMA to utilize the information I have provided above, and the information in the public domain, to determine if and how my rights have been violated so we may discuss what actions are appropriate to save my home.

    I understand that Consumer Advocates PMA has granted me a 14 day membership to their Private Membership Association. Being a member of the PMA will allow me to discuss with the Consumer Advocates PMA staff the results of the investigation and options to save my home within the four corners of the PMA and my First Amendment rights.

    Agreed to: Name: Date: