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[X] Yes, Russ, here's my information. I need your help. I need a FAST solution.

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Name *
E-mail Address *
Most Important Financial Problem *	Balloon mortgage coming due Unpaid property taxes Payroll tax issue Unfiled tax returns Business cash flow issues In need of working capital Foreclosure Tax lien(s) Judgment(s) Credit challenges Mortgage lates Debt consolidation Want to buyout other partner(s) Purchase Building for My Business Construction/Rehab Other (list specifics below)
Other Financial Problems (please be as specific as possible.)
What is most important to you?
How much do you need to solve your financial problem?
Current Real Estate Value $
Current "As Is" Real Estate Value $
Your Full Name (First Middle Last)
Home Address, City, State, Zip Code
Own or Rent Home
Number of Years in Home
Home Telephone Number
FICO Middle Credit Score (approximate) *
Office Telephone Number *
Cell Telephone Number
FAX Telephone Number
Best Number to Call
What is the best time to call you
How is title held to property?
Commercial Property Type
Property Address, City, State, Zip Code
County Where Subject Property Is Located
Total # of Units
Occupancy %
Owner Occupancy %
Square Footage
Business Name
# of Years in Business
Company Revenue per Year (Owner-Occupied only)
Company Net Profit per Year (Owner-Occupied only)
Occupancy Type
Yearly Gross Rental Income $
Yearly Building Expenses $
Fuel Storage Tanks
Original Cost $
Date Purchased
Current 1st Mortgage Balance $
Balloon Due Date
Current 2nd Mortgage Balance $
Comments / Other Information

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