www.SuperSmartSaveSite.com - Emergency Help Form!

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SuperSmart

In order for us to serve you best, please complete the form below. We'll review your information and contact you very soon to discuss all possible solutions. All information provided will be kept strictly confidential (Privacy Policy). If you don't need emergency help to save your home, click here to Sell Your House in 7 Days or Less or to contact us by email now.

Click here to use our Secure & Confidential Questionnaire

C O N F I D E N T I A L

*Items marked with a red asterisk are required. If you're unable to answer a required question, give us your best guess or enter a "?", "NA", "0", "don't know", etc. If you have any problem submitting this form, please contact us and let us know. Click here to use our Secure & Confidential Questionnaire.

Your Contact Information
*First Name(s)	*Day Phone	Example: 123 456-7890
*Last Name	*Evening Phone
*Email	Cellular Phone
	*Best Time to Call

Your Situation

*Has your lender started the foreclosure process on your home?

Yes No

*What's your situation? How did you fall behind on your mortgage payments?

*Has a foreclosure sale date been set? If so, when?

Your Property Information

*Address

*City

*State

*Zip

*County

Property Type

Bedrooms

Bathrooms

Square Footage

Year Built

Stories/Floors

Garage

Basement

Lot Size/Acres

How long have you owned this house?

What is the current condition of your property?

What kind of repairs and maintenance does the house need?

Who is currently living in the house?
Is the house currently listed with a ^®Realtor?			Yes No
If yes, how long has your house been for sale?

Financial Information

Please provide the following information on your mortgage(s) and current financial situation...

	1st Mortgage	2nd Mortgage	3rd Mortgage
*Lender's Name
Balance	$	$	$
Payment	$	$	$
Payments Current?	Yes No	Yes No	Yes No
If No, how far behind?	$	$	$
How much are your total annual property taxes?			$
*Are your property taxes and insurance included in your monthly payment?			Yes No
If your house were appraised, how much do you think it would be worth?			$
*How much cash do you have to put towards stopping the foreclosure?			$
*How much do you think you can afford to pay monthly, in addition to your current mortgage payment, to save your home?			$
How long can you afford to pay this monthly payment?
*Are you currently in a Chapter 7 or 13 Bankruptcy?			Yes No
*Are you currently capable of making your minimum monthly payments on all your debts?			Yes No
Do you have a 401K or whole life insurance policy?			Yes No
*How did you hear about us?

Do you have any questions or comments you would like to share with us?

*Verification
1428

Enter verification code (in red) to the left.
Without this code your information will not be submitted

C O N F I D E N T I A L

Thank you for taking the time to share your information about your home with us.
We will review your information and contact you shortly.
If you have any problem submitting this form, please contact us and let us know.

www.SuperSmartSaveSite.com
2700 Braselton Highway
Suite 10-283
Dacula, GA 30019
Contact Us Now!
(770) 904-2508 ext 2

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