1. Is the mortgage you are having problems with your primary residence? Yes No

2. Have you missed any mortgage payments? Yes No

3. Do you anticipate having difficulties making your mortgage payments moving forward? Yes No

4. Do you believe that the amount you owe on your mortgage(s) is greater than the current value of your home? Yes No

5. Have you received a forclosure notice (Notice of Default or Lis Pendens) from your lender? Yes No

6. Are you considering or currently in bankruptcy? Yes No

7. Have you attempted to work with your mortgage company to resolve your situation? Yes No

8. Have you attempted to refinance or modify your loan and been denied? Yes No

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