TN LOSS MITIGATION SERVICES LLC

SHORT SALE QUALIFICATION FORM We are here to help you stop the foreclosure process and start your life over again. Our team is experienced, professional, compassionate and discreet. Your information is secure and never shared outside of our organization. Let's find out how TLM can help you get your home sold today!

Name * Title First Last Suffix
Email:
Address * Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Are you the homeowner? We can only work with the actual homeowners whose names are reflected on the note and/or Deed of Trust for that property. * YES NO
Have you received anything in the mail or hand-delivered? We need to know if you have anything from your lender, law firm or investor regarding the status of your loan. Received mail from Lender Received mail from Law Firm Note left on my door
Type of Property * Single Family Condo/Town-home Duplex Multi-Family Commercial
How many months behind are you on payments? * 1 Month 2 Months 3 Months 4 Months 5 Months 6+ Months
Are you currently working with your lender on catching up? * YES NO
Are you able to re-pay the back balance? * YES NO Not within the next 12 months
Have you ever filed for bankruptcy? * YES NO Thought About It
If you answered "yes" to the above, when did you complete bankruptcy?
Are you current employed? * YES NO Laid Off Disabled Retired
Number of Children and/or Dependents
Primary Lender *
Primary Loan Number *
HELOC or 2nd Note on Property? * YES NO
Name of Secondary Lender Identify HELOC or 2nd Mortgage lender
Account Number of Secondary Lenderr
Are there any other loans and/or liens against the property? YES NO MAYBE NOT SURE
Please describe known or possible liens against property
Are the taxes paid and up to date for the property? * YES NO
Do you have a current Homeowner's Insurance Policy for the property? * YES NO
Are the taxes and insurance escrowed? * Both Escrowed None Escrowed Insurance Only Taxes Only What is Escrow!??!!
What is the balance owned on the Secondary Loan? $ . Dollars Cents
What is the balance owed on the Primary loan? $ . Dollars Cents
Other balance amounts owed on the property $ . Dollars Cents
Property Status This property is currently.... * Owner Occupied Tenant Occupied Vacant
Is your home currently listed with an agent? * YES NO
When is the best time to contact you? * Morning Noon Night Weekdays Weekends
What is your best contact number? * - - ### ### ####