Payment Worksheet
Financial Overview
Borrower
Property Information
Address
Loan #
yes
no
City, State, Zip
Property for Sale
Home Phone
Listing Date/Price
Work Phone
Realtor Name
Cell Phone
Realtor Phone
# in Household
Assets
Amount Owed
Value
Length of Ownership
____ yrs ____months
Home
$
$
Co-Borrower
Real Estate (Other)
$
$
Address
Checking
$
City, State, Zip
Savings
$
Home Phone
Investments
$
Work Phone
Retirement
$
Cell Phone
Auto 1
Model ________
Year ________
$
# in Household
Auto 2
Model ________
Year ________
$
Length of Ownership
____ yrs ____months
Auto 3
Model ________
Year ________
$
Income Overview
Description of Hardship
Employer
Gross Monthly Wage
$
Please answer the following questions to help us better understand
$
your current situation:
$
What caused you fall behind on your payments?
Additional Income* -
Monthly Amount
_______________________________________________________
alimony/child support/etc.
_______________________________________________________
$
$
_______________________________________________________
* Additional income does not need to be reviewed if you do not choose to have
it considered for approval of a payment workout.
Can you make a down payment toward a resolution plan?
Expense Overview
yes
no
If yes, how much? __________________
Monthly Expense
Monthly $ Amount
Mortgage
$
How and when will your situation change in the future?
2nd Mortgage
$
_______________________________________________________
Auto Payment(s) # _____
$
Auto Insurance
$
_______________________________________________________
Auto Maintenance/Fuel
$
_______________________________________________________
Credit Card Payments
$
Installment Loan Payments
$
Best time to contact: ____________
am
pm
Child Support/Alimony
$
Preferred method of contact:
phone
email
Day Care/Child Care/Tuition
$
Food
$
Email address: _____________________________________
Utilities
$
Telephone
$
I agree that the financial information provided is an accurate statement of
Cable
$
my financial status and by signing, I authorize the mortgage servicer to
Medical
$
order a credit repot, verify any employment, bank account or assets and
Home/Condo Association Dues
$
release any information concerning the above.
Spending Money
$
Please sign and date (required):
Other Misc Expenses
$
Borrower signature _______________________________ __/__/__
Co-Borrower signature ____________________________ __/__/__