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Hard Ship Assessment Form

This form is designed to help Cloud 10 Financial Inc and HomeOwner 911 collect specific data regarding YOUR financial situation and needs. A full and complete form is key in collecting data so we know what options to recommend for you. Once we receive a completed hardship assessment form we are able to apply the information to our very own “Home Owner Hardship Model.” This will allow us to do the following:

See what options are available to help you save your home
Hunt for alternate financing to see if we can help refinance through hardship investors or our non-profit and bank affiliates.
Work on a strategy to negotiate discount pricing with your current bank to lower your payments
See what other options exist and what strategy we will recommend for you by understanding your “hardship level”
Develop an exit strategy and method to avoid foreclosure (this only applies to those looking to exit the property as they are at the toughest stage of hardship).

There are four stages of hardship in our model and 1001 decisions you have to make regarding money now. When finances are tight it is important to make the best decision by knowing where you are and what is there for you. This assessment form allows us to understand your needs more, and helps us narrow the choices so you can make an informed decision.

Please take a 5 minutes to complete this form so we can obtain a clearer understanding of your situation and provide some clarity to your situation.

When the market HURTS you, we are here to HELP you!!

Section #1 Customer Information
Name:
Street Address:
City:
State:	Zip:
Email:
Cell Phone:

Home Phone:
Work Phone:
Fax:
Section #2: Mortgage Information:
A) What is the estimated balance on your first mortgage?
B) Do you have a second mortgage on your property? Yes No
If Yes what is the approximate balance of the second mortgage?
C) How delinquent are you on your monthly mortgage payments?
D) How much are you behind in your monthly mortgage payments
E) Please enter the name of your mortgage companies in the box below. Also feel free to include any information about your mortgage accounts that you think may be helpful for us to know.

Based on how you see your current situation what would you like to see happen.

Section #3 - Leverage and Finace Review
How is your credit card payment history?
How are you on paying your car payments?
Regardless of your credit score and income do you think you have equity in your home? Yes No
If yes what amount of equity do you think is remaining?
What is your approximate credit score?
Credit Bureau Disclosure: We would like your permission to pull your credit bureau and review your credit file and score with all three major bureaus, which is an important part of the overall assessment. You have the right to decline this. Do we have you permission to pull your credit report so we may best review your overall situation?
	Yes please pull it so you can use it to advise me of my option
	No, do not pull my credit I do not give permission
	Not at this time, lets discuss first so I can see advantages
Do you have any 401 K balance? Yes No
If yes what is approximate balance:
Do you have any liquid assets such as stocks, cash in savings, ECT? Yes No
If yes please indicate the actual amount:
How much money do you have on available credit cards?
Have you considered asking someone in your personal network to help you get back on track whether they use their credit, or equity or available cash resources?

If other or additional comments please detail in box below:

Section #4 Hardship and Resource Review:
What is the main source of your hardship?
Comments:

Have you asked your bank to reduce your monthly mortgage payments or give you some break? Yes No
Have you asked any non-profit financial services agency for help with your situation? Yes No
Are you enrolled in a consumer credit counseling group at this time? Yes No
Are you currently working with any debt settlement service provider? Yes No
Have you filed for bankruptcy protection at this time? Yes No
Do you own more than one property? Yes No
Do you have an attorney already that you discuss hardship matters with? Yes No
Section #5 Income Review
What type of employment do you have at this time:
How is your overall income situation at this time:

Section # 6 Exist Strategy Review
Do you think you are heading into foreclosure and want to explore what options are there to help you? Yes No
Have you received a notice of default from your lender yet? Yes No I don't know
Have you received notice of a trustee sale date? Yes No I don't know
Have you worked with your banks loss mitigation team to help restructure your loan payments ? Yes No I don't know
What is your goal with your home at this point?

Please list any comments you would like us to know about your financial hardship as it may help us understand more about what direction to recommend to you and your family?

How did you find this Form?