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Section A: Mortgage Lates
Within the last 24 months have you had any late payments on your mortgage?
* If yes, continue, otherwise skip to section B.
Number of Mortgage Lates
Within the last 12 months Between 13 and 24 months ago
30-59 days late
30-59 days late
60-89 days late
60-89 days late
90+ days late
90+ days late

Are you currently late on your mortgages?   

Section B: Consumer Loan Lates
Have you had any late payments on your credit cards, auto loans, student loans or any other consumer debts?
* If yes continue, otherwise skip to section C.
Number of Consumer Lates
Within the last 12 months Between 13 and 24 months ago
30-59 days late
30-59 days late
60-89 days late
60-89 days late
90+ days late
90+ days late
Are you currently late on your consumer loan payments?

Section C: Collections, Charge offs, Judgements, Tax Liens
Do you have any collections, charge offs, judgements or tax liens?

Section D: Bankruptcies
Have you been bankrupt during the last 7 years?

Section E: Foreclosures
Have you had any foreclosures during the last 7 years?

Section F: Payment load
Do you have a lot of consumer debts, such as credit cards, auto loans, student loans, etc.?

Section G: Equity in your property
The value of my house is $
The total amount of loans on my house are $

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