American Mortgage Debt Resolution, Inc.

American Mortgage Debt Resolution, Inc.

Preliminary Client Intake Information

     Help us serve you better by completing this form as accurately as possible.
     Please be aware that no-one can yet guarantee the privacy of information transferred over the "net." If you have concerns feel free to omit any item marked (o) for optional. Once in our office your information shall remain confidential as per our privacy statement.;
     Thank you,
     AMDR, Inc.

Please read this before continuing.  Important!
     When you encounter checkboxes, please click your mouse in the appropriate box. If not clicked, the checkbox will return the highlighted value.
     Please do not use any semi-colons (";") in data-entry fields. Using semi-colons will make your input un-usable on our end.
     You may find it useful to use your browser's file function to "print" this file out (you'd get about 8-9 pages), then log off, work on the hard copy at your leisure, and log back on when you're set to go!
     Another reason for working in this fashion is that many browsers will not support "piecemeal" work on this form, so it's best to be able to sit and complete this in one session.
     You will be asked later on to enter your cars' value. It would be a good idea to go to AutoPrices.Com now to get the values for your cars, use the wholesale or loan value.
     Again, since many browsers will not retain data you enter in this form after you link to another site, so we advise that you go to the site now to get your car values, write them down, and then return here to begin completion of this form.
     If you are having cash flow problems unrelated to an identifiable financial event (such as the loss of a job or unexpected medical expense), we recommend you fill out the Monthly Expense Form before proceeding with this preliminary intake form. Use the Monthly Expense Form to get an accurate pirture of your spending before answering questions on this intake form.

Enter Basic Information

Enter Information about Prior or Pending Bankrupty

Enter Information on the Real Estate

Foreclosure Information (enter any applicable dates)

Info on the first mortgage

Info on second mortgage, if any

Info on your income, assets and debt

Loan refinancing info, if known

Regarding interview, fee quotes and payment

Submit this Information

Please check which response you´re looking for from us, and remember that all consults must be pre-paid. If no option is selected, this form will not be processed:

We would appreciate knowing how you heard about us. Please take a moment to send us this information here:
We found your site in this way: (o)

We didn't find your site like that, we found it like this:

These questions are basic information, name(s), address, phone(s):

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Your last name (o)
Your first name
Your date of birth (o)
Your SS# (o)
Your significant other situation
Partner's last name (o)
Partner's first name
Partner's SS# (o)
Daytime phone number (o)
Evening phone (o)
Fax number (o)
E-mail address
Pager # (o)
Who referred you?(o)
With whom does that person work? (o)
Your street address (o)
City
State
County (o)
Zip (o)

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These questions are about any previous or pending bankruptcy actions you may have filed.

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Have you or co-borrower ever filed bankruptcy?	Yes No
What chapter did you file under?	N/A 7 13 9 11 12
Date filed?
Date closed or dismissed?
Please use this area to describe the circumstances of the bankruptcy, and to provide information about any additional bankruptcy filing which is not listed above.

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These questions are about the property which is subject to the distressed mortgage.

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What is the address of the property that has the mortgage in trouble? (o)
Is this a single-family home or a multiple family dwelling?
	If multi-family, number of units:
Is this an owner-occupied or a non-owner- occupied dwelling?

These questions are about the value of the property. In some instances, you may not know an answer, so type in "unknown." In some instances, the answer may be "not yet obtained." A "Broker's Price Opinion" is a specialized valuation of the property. A "Broker's Price Opinion" may not yet have been obtained. Feel free to call a licensed real estate broker in your area and ask her or him to give you a Price Opinion. If they're uncertain about this, ask them, "If I had to absolutely be certain of selling this house within the next 30 days, what price would I get?"
Home Value By Owner (This field is required. Please give us an idea of what you think the property is worth.)
Home Value By Appraiser
Home Value By Mortgage Co.
Home Value By Assessor (This field is required. Please call the assessor's office if you don't have a copy of your most recent tax bill.)

If you have obtained "Broker's Price Opinion," or if someone else has obtained one enter the dollar amounts here.
Source of 1st opinion eg. Broker, brother-in-law, banker friend, etc.	Amount of Valuation
Source of 2nd opinion	Amount of Valuation
Source of 3rd opinion	Amount of Valuation

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These questions are about Massachusetts foreclosures, but should be answered if they apply.

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Soldier and Sailors Date
Foreclosure Date
Eviction Date
Execution Date

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These questions are to identify the Bank, the type and amount of mortgage and arrears, and the name and number of the bank's attorney, for the FIRST mortgage on the property.

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Who is reasponsible for this mortgage? (Whose name(s) are on the note and mortgage
1st Mortgagee Bank's Name (o)
Principal balance
Interest rate
Monthly payment
Includes taxes?	Yes No
Includes insurance?	Yes No
Arrears, in dollars ($) or months (mo)
Includes legal fees and foreclosure-related costs?	Yes No don't know
Bank's Street Address (o)
City, State and Zip (o)
Mortgage loan or account # (o)
Type (conv/VA/FNMA/etc.)
Is there "private mortgage insurance?" If you don't know, call your bank and find out the answer to this. You're entitled to the information, and we need it.	Yes No
Bank contact person (o)
Bank phone number (o)
Bank's Attorney's name (o)
Attorney's firm name (o)
Attorney's phone number (o)
Attorney's fax line (o)

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These questions are to identify the Bank, the type and amount of mortgage and arrears, and the name and number of the bank's attorney, for the SECOND mortgage on the property.

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2nd Mortgagee Bank's Name (o)
2nd Mortgage principal balance
2nd Mortgage interest rate
Monthly payment
Includes taxes?	Yes No n/a
Includes insurance?	Yes No n/a
Arrears, in dollars ($) or months (mo)
Includes legal fees and foreclosure-related costs?	Yes No n/a don't know
Bank's Street Address (o)
City, State and Zip (o)
Mortgage loan or account # (o)
Type (conv/VA/FNMA/etc.) (o)
Is there "private mortgage insurance?" If you don't know, call your bank and find out the answer to this. You're entitled to the information, and we need it.	Yes No n/a
Bank contact person (o)
Bank's phone number (o)
Attorney's name (o)
Attorney's firm (o)
Firm's Street Address (o)
Firm's city, state, zip (o)
Attorney's phone (o)
Attorney's fax line (o)

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Here we need other debt info., information about your assets and about your income and ready cash.

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$ amount of any other liens on the property. Include 3rd and 4th mortgages here.
$ amount of any back real estate taxes owed
Total $ amount of all credit card debt
Do you have any other back taxes owed?	Yes No
What kind of taxes?
Total taxes due
For what years?
Do you have any student loans payable?	Yes No
Total amount of loan(s)
Has payment on the loans been deferred?	Yes No
When will you need to begin to pay?
Total $ amount of all other debt
Yr., make, model of car#1
Value of car#1
Loan balance, car#1
Yr., make, model of car#2
Value of car#2
Loan balance, car#2
Yr., make, model of car#3
Value of car#3
Loan balance, car#3
$ amount of other secured debt, on boats, RVs, airplanes and similar big-ticket items
Total $ in savings
Total in 401Ks
Total in IRAs
Cash surrender value of life insurance
Are you the beneficiary of any trust, or do you have an expectancy in any estate? Put crassly, is anyone expected to die in the near future and leave you money that could help your situation? Who? When? How much?
Total $ value of all other assets
Your gross monthly income (remember to multiply weekly times 4.3, as there are about 4.3 weeks in one month)
Your take-home pay, after all payroll deductions, but BEFORE you make your mortgage payment
Your partner's monthly gross
Your partner's pre-mortgage take-home pay
Your family's monthly net income, BEFORE paying your mortgage
What is the absolute, but REALISTIC maximum amount you can spend each month on your mortgage, payments, taxes and insurance?
What is the maximum amount of CASH (greenbacks or certified or bank checks) you have, together with what you could "beg, borrow or otherwise obtain" within 30 days if necessary to make a lump sum payment, eg. for a refinance mortgage or similar payment?

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These questions are about refinancing loan approval, and can be skipped if they don't apply or if you don't know the answers.

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Approved loan ratio, if known
Approved int. rate, if known
Name of contact person at proposed new Mortgage Company (o)
Name of proposed new Mortgage Company (o)
Phone number for contact person (o)
Fax number for contact person (o)

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These final questions deal with personal interview and fee structure and payment, and may be left blank if they are not yet dealt with.

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What have we recommended, if we have already discussed this with you?
When were you interviewed?
Who interviewed you, or are you completing this on your own? (Delete and overwrite if this was generated during an interview.)
Have you printed, signed and sent in the retainer agreement?	Yes No
What caused you to be in financial distress?
How have you resolved the problems you cited above?
Are there any other special circumstances we should be aware of?
We have time stamped this form and issued an order number as shown to the right. Please write this date and time down, it will identify your form for us, particularly if you do not include your name.

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Submission

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**©American Mortgage Debt Resolution, Inc.** (1-800-351-3301),
By Mory Brenner, Esq.9/2/99 3:21 PM
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Author: John P. Green, Esq.
The following is a Link Exchange ad, it has not been reviewed or endorsed by Attorney Brenner.
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These questions are basic information, name(s), address, phone(s):

These questions are about any previous or pending bankruptcy actions you may have filed.

These questions are about the property which is subject to the distressed mortgage.

If you have obtained "Broker's Price Opinion," or if someone else has obtained one enter the dollar amounts here.

These questions are about Massachusetts foreclosures, but should be answered if they apply.

These questions are to identify the Bank, the type and amount of mortgage and arrears, and the name and number of the bank's attorney, for the FIRST mortgage on the property.

These questions are to identify the Bank, the type and amount of mortgage and arrears, and the name and number of the bank's attorney, for the SECOND mortgage on the property.

Here we need other debt info., information about your assets and about your income and ready cash.

These questions are about refinancing loan approval, and can be skipped if they don't apply or if you don't know the answers.

These final questions deal with personal interview and fee structure and payment, and may be left blank if they are not yet dealt with.

Submission