Axia Financial, LLC

LOAN MODIFICATION PREQUALIFICATION WORKSHEET

Client Name: Application Date:

Phone:
email: SLM Affiliate/Principal:
Street Address: Phone:
City, State, ZIP Fax:
Email:
MONTHLY CASH FLOW MORTGAGE INFO Referral Partner
INCOME $0.00 Loan Amnt (1st)
EXPENSES $0.00 2nd Loan:
CASH FLOW $0.00 Total: $0.00 ELIGIBLE FOR
Est. Value LOSS MITIGATION?
MONTHLY EXPENSES Amnt CLTV: #DIV/0!
HOME
Mtg Pymt: MONTHLY INCOME QUALIFYING QUESTIONS
2nd (if applicable): BORROWER PROPERTY QUESTIONS
Taxes: Full-Time Job Currently in Foreclosure or received NOD
MI: Part-Time Job If So, Date
HOI: Self-Employment Is there a Notice of Sale
HOA Fees: Social Security: If So, Date
UTILITIES Pension: Occupancy (O/O, N/O/O, or vacant)
Electricity Unemployment
Gas Disability Loan seasoned > 1 year?
Water Child Support
Sewer/Garbage Alimony Currently behind on Mortgage, how long?
Phone Rental Income #1
Cable/Internet Rental Income #2 Currently in a chapter 7 or 13 BK?
Cell Phone/Pager Rental Income #3
NECESSITIES CO-BORROWER MORTGAGE QUESTIONS
Groceries Full-Time Job Name of Lender(s)?
Household Supplies Part-Time Job
TRANSPORTATION
Car Payment #1 Self-Employment Type of Loan (Fixed, Adj, Neg Am)?
(Model, Yr below) Pension:
Auto Insurance:
Car Payment #2 Social Security: If Adj, when?
(Model, Yr below) Unemployment Has the loan been modified
Gasoline Disability within the last year?
Auto Maintenance Child Support
Mass Transit Alimony Current Interest Rate?
INSURANCE Rental Income #1
Medical/Dental Rental Income #2 Mortgage Lates?
Life/Disability Rental Income #3
UNSECURED DEBTS
Credit Card #1 TOTAL INCOME $0.00
Credit Card #2
Credit Card #3 Hardship /reason for needing a modification
Student Loans
Personal Loans
Other
CHILD CARE/EDUCATION
School Lunch
Tuition/Books
Child Support
Daycare
MEDICAL EXPENSES
Pharmacy/Prescriptions
Hospital/Clinic
ENTERTAINMENT
Dining Out
Movies/Shows
Hobbies
MISCELLANEOUS
Misc Expense #1
Misc Expense #2

TOTAL MONTHLY EXPENSES $0.00