Client Information Form

Date: ____________________

Name:____________________________________________Email:__________________________________
Address:_________________________________City:____________________________ZIP:____________
Phone: __________________________________Cell: ____________________________________________

ND/NT DATE

Lender

Contract Date

Demand Letter Date

Clients Attorney

Date Suit filed

Loan Amount

Interest
Rate

1st Loan #

Lender phone

Date Lis Pendens

approval

First Court Date

Payment

Trustee Phone #

Bankruptcy Filed

Lender

Trustee Sale #

Credit Repair
Start Date

Back
payments/
Taxes/Liens

1
2
Total
Payment Coupon:_______
Trustee Contact:_______________________

Insurance Proof:_______
Signed Authorization w/ SS#

Date of Birth: ______-_____-_________ Social Security #:_______-_____-_________

Date of Birth: ______-_____-_________ Social Security #:_______-_____-_________

Notes: ___________________________________________________________________