Housing Options Survey

1. How many times have you wished you could talk to someone about your home mortgage due to a rate adjustment that has occured or is about to occur?

	Never	Once or twice within the past year	More than I care to admit	Who cares about the mortgage...I'm outta here	Doesn't apply
1st loan	How many times have you wished you could talk to someone about your home mortgage due to a rate adjustment that has occured or is about to occur? 1st loan Never	Once or twice within the past year	More than I care to admit	Who cares about the mortgage...I'm outta here	Doesn't apply
2nd loan	2nd loan Never	Once or twice within the past year	More than I care to admit	Who cares about the mortgage...I'm outta here	Doesn't apply
3rd loan	3rd loan Never	Once or twice within the past year	More than I care to admit	Who cares about the mortgage...I'm outta here	Doesn't apply
4th loan	4th loan Never	Once or twice within the past year	More than I care to admit	Who cares about the mortgage...I'm outta here	Doesn't apply

Other (please specify)

2. How far behind on your payments are you?

	Never	30 days	60 days	90 days	Over 90 days
1st loan	How far behind on your payments are you? 1st loan Never	30 days	60 days	90 days	Over 90 days
2nd loan	2nd loan Never	30 days	60 days	90 days	Over 90 days
3rd loan	3rd loan Never	30 days	60 days	90 days	Over 90 days
4th loan	4th loan Never	30 days	60 days	90 days	Over 90 days

3. Has there been some unfortunate event that has changed your financial situation?

	Self	Spouse	Family Member
Job Loss	Has there been some unfortunate event that has changed your financial situation? Job Loss Self	Spouse	Family Member
Pay Reduction	Pay Reduction Self	Spouse	Family Member
Accident	Accident Self	Spouse	Family Member
Illness	Illness Self	Spouse	Family Member
Death in family	Death in family Self	Spouse	Family Member
Other	Other Self	Spouse	Family Member

4. Have you taken any steps to remedy your situation?

Have you taken any steps to remedy your situation? Spoke with my bank

Talked with my real estate agent

Have been thinking about it but am too embarrassed

Don't know what to do

Doesn't apply to me

5. Are you aware of the differences between:

	loan modifications	short sales	foreclosures
Yes	Are you aware of the differences between: Yes loan modifications	short sales	foreclosures
No	No loan modifications	short sales	foreclosures
Don't know	Don't know loan modifications	short sales	foreclosures

*

6. If you would like to be contacted to discuss your housing situation please fill out the information below and a Certified Distressed Property Expert licensed by the Dept. of Real Estate will contact you. Please select your preferred method of contact.

If you would like to be contacted to discuss your housing situation please fill out the information below and a Certified Distressed Property Expert licensed by the Dept. of Real Estate will contact you. Please select your preferred method of contact. Name:
Address:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number: