How did you learn about Craig Coleman?

The things I most want Craig to do for me are:

1.

2.

3.

4.

5.

I am in credit counseling Yes No

Name:

Homeowner 1 FULL NAME? SSN:

Date of Birth:

Homeowner 2 FULL NAME? SSN:

Date of Birth:

Person to contact Homeowner1 Homeowner2

E-mail address:

Home phone number: I'm at home: Days Evenings Both

Work phone number: I'm at work: Days Evenings Midnights

Home Address :

Street: City: Zip:

I have rental income property Yes No

Address of rental income property 1:
Street: City: Zip:

I have more rental income properties Yes No

Purchased:

I bought the owner-occupied property in (year):
Purchase price:

I bought the rental income property in (year):
Purchase price:

Value of my property(ies):

Owner-occupied: $

Rental property 1: $


Owner-occupied:
Have any properties been listed for sale with a Realtor in the last 12 months?: Has been listed within last 12 months Has NOT been listed within last 12 months

Rental income property 1:
Has been listed within last 12 months Has NOT been listed within last 12 months

Property Descriptions:
brick frame
Single Family 2 Legal Units 3 Legal Units 4 Legal Units 5 or More Legal Units
Total number of bedrooms in house:
Total number of FULL bathrooms in house:
Total number of HALF bathrooms in house:

Rental property 1:
brick frame
Single Family 2 Legal Units 3 Legal Units 4 Legal Units 5 or More Legal Units
Total number of bedrooms in house:
Total number of FULL bathrooms in house:
Total number of HALF bathrooms in house:

Mortgages:

Owner-occupied:
Number of loans on property?:
Dollar amount of debt on 1st loan?: $
Dollar amount of debt on 2nd loan?: $
Dollar amount of all OTHER loans on property? (combined): $

Rental property 1:
Number of loans on property?:
Dollar amount of debt on 1st loan?: $
Dollar amount of debt on 2nd loan?: $
Dollar amount of all OTHER loans on property? (combined): $

Property Taxes:

Owner-occupied:
ANNUAL amount of property taxes?: $

Taxes are: included in mortgage not included in mortgage
Taxes are: Paid up not paid up
I owe number of installments.

Rental property 1:
ANNUAL amount of property taxes?: $

Taxes are: included in mortgage not included in mortgage
Taxes are: Paid up not paid up
I owe number of installments.

Homeowners' Insurance:

Condo owners: check "condo" and skip remainder of insurance section.

Owner-occupied:
Condo? Yes no
Insurance is included in mortgage not included in mortgage
Insurance is $ per YEAR.
I am behind on my insurance Yes no

Rental property 1:
Condo? Yes no
Insurance is included in mortgage not included in mortgage
Insurance is $ per YEAR.
I am behind on my insurance Yes no

Condo Assessments :

Owner-occupied: $ /month.

Current Delinquint
I am months behind.

Rental property 1: $ /month.

Current Delinquint
I am months behind.

Income:

Homeowner 1:
Main Employment: Wage-earner Self-employed

My income is : W-2 income 1099 income

Income before taxes: $ a year a month twice a month every two weeks weekly

Time on job: years, months

Job title:

Employer name:

Part-time/secondary Employment:

Main Employment: Wage earner Self-employed

My income is : W-2 income 1099 income

Income before taxes: $ a year a month twice a month every two weeks weekly

Time on job: years, months

Job title:

Employer name:

I have additional income yes no $ /month

Type of income:


Homeowner 2:
Main Employment: Wage-earner Self-employed

My income is : W-2 income 1099 income

Income before taxes: $ a year a month twice a month every two weeks weekly

Time on job: years, months

Job title:

Employer name:

Part-time/secondary Employment:

Main Employment: Wage-earner Self-employed
My income is : W-2 income 1099 income

Income before taxes: $ a year a month twice a month every two weeks weekly

Time on job: years, months

Job title:

Employer name:

I have additional income yes no $ /month

Type of income:

There are additional people on title to the owner-occupied property Yes No

There are additional people on title to rental income property 1 Yes No