Pre-Qualification Application

To Assist With Our Inquiry Process
JHA's loan modification specialists' role under JHA'S Making Home Affordable Initiative is to review your financial situation and mortgage terms to determine if your family qualifies for the current US Treasury program or any other program that might be available with your mortgage servicer to reduce your current mortgage payment. We do not offer refinancing of mortgages. We offer, free of charge, negotiation and mortgage expertise to assist you in navigating the complex process of working with your mortgage servicer.

To better serve you we now offer an online form.
If you wish to inquire about our services online rather than by phone, please complete the form below. Someone will contact you to confirm your information and discuss our review process.

* Required

First Name*

Last Name*

Street Address*

City*

State:

ZIP code*

Primary Phone Number*

Alternate Phone Number

Best time to reach you

Email Address*

Number in household
# of Adults # of Dependants

Is only your name on the Mortgage Yes No
If No, please list other name(s) on the mortgage.

Total Monthly Gross Household Income

Total Monthly Household Expenses

First Mortgage Company

First Mortgage Payment Amount

Includes Taxes?Yes No
Includes PMI? Yes No
Includes Homeowners InsuranceYes No

Second Mortgage Company

Second Mortgage Payment Amount

Total annual homeowners insurance paid (if not escrowed)

Total annual property taxes paid(if not escrowed)

Are you behind in any living expenses?Yes No
If yes, please list

Are you behind in paying your property taxes, income taxes or any other business taxes?
Yes No
If yes, please list

Do you currently have healthcare insurance?Yes No

Are you currently using credit cards, 401K, other investments or help of family or friends to pay your living expenses at this time?Yes No

Please describe what event or events have occurred that have or are contributing to your inability to meet your financial obligations and/or housing expenses.

Are you currently behind in paying your mortgage payments?Yes No
If yes, # of months behind on first

# of months behind on second

How much unsecured debt do you have?

Are you currently in Bankruptcy?Yes No
If yes, date filed

Are you currently in foreclosure?Yes No

To prevent SPAM please enter the code you see above.
This is case-sensitive: