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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

60-89 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

60-89 days late

90+ days late

Are you currently late on your consumer loan payments?

Section C: Collections, Charge offs, Judgements, Tax Lien

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 $

Lenox Financial Mortgage Corporation -
Office Phone: 888-395-3669 Fax: (949) 428-5101

Lenox Financial Mortgage Corporation; CA: Licensed by the Department of Corporations under the California Residential Mortgage Lending Act. MN: This is not an offer to enter into an agreement. Any such offer may only be made pursuant to Minn. Stat. § 47.206 (3) & (4), OR: licensed by the Department of Business & Consumer Services as “Park Plaza Mortgage”. Not all programs available in all areas. Underwriting guidelines apply to all loan programs. Program restrictions apply. Programs subject to change at anytime and without advance notice.