National Foreclosure Settlement Form

Indicates required field

Contact Information

Prefix

First Name

Last Name

Name of Business

Title

Street Address

City

State

Zip

Country

County

Phone

E-mail

Confirm E-mail

Borrower Information

Prefix

First Name

Last Name

County

Name of Business

Current Street Address

City

State

Zip

Country

Phone

Co-Borrower Information (if any)

Prefix

First Name

Last Name

County

Name of Business

Current Street Address

City

State

Zip

Country

Phone

Property Subject to the Mortgage

Mortgage Address Street Address

City

State

Zip

County

Mortgage Information

Name of bank that serviced the mortgage loan

Please select which statement applies to you

Borrower is delinquent on loan or having difficulty making mortgage payments

Borrower is current on mortgage payments and interested in refinancing

Other (briefly explain)

Questions/Comments

60 or older

Yes

(Penalties can be enhanced for victimizing senior citizens)

Military status?

Active

Veteran

N/A

I understand that your office does not give legal advice. I also understand that your office cannot take legal action for me individually.

I am filing this complaint to notify your office of the activities of this business/individual and to seek any assistance you may be able to render.

TOLL FREE: 1-866-9-NO-SCAM

National Foreclosure Settlement Form

Contact Information

Borrower Information

Co-Borrower Information (if any)

Property Subject to the Mortgage

Mortgage Information