Debt Restructuring New Submission

Cash Funding Options, LLC 1 4625 S Lakeshore Dr Tempe, AZ 85282

ACQUISITION REPRESENTATIVE: 888-341-3802 Toll Free 602-314-1025 Office 480-240-1316 Fax [email protected] DEBT RESTRUCTURING NEW SUBMISSION Version 312010 SELECT ONE:  PRINCIPAL REDUCTION  SHORT SALE  LOAN MODIFICATION

Fax New Submissions to: 480.240.1316 AFFILIATE INFORMATION

Affiliate Name:

Email:

Please fill out this form via your computer, by typing into the fields. If this is not an option, please PRINT clearly!! 2

Borrower Information & Financial Statement Part A- Borrower(s) Information

NOTICE: Please complete this form, as your lender will require ALL this information.

Borrower Name: Social Security #: Co-Borrower Name: Social Security #:

Borrower Birth Date E-Mail Address Co-Borrower Birth Date: E-Mail Address:

Borrower Phone #: Co-Borrower Phone #:

Borrower Home Address: Co-Borrower Home Address

City: State: ZIP: City: State: ZIP:

Part B- Borrower(s) Employment Information Employer Name: Position Held: Employer Name: Position Held:

Employer Address: Employer Phone#: Employer Address: Employer Phone#:

Employer City: State: ZIP: Employer City: State: ZIP:

Employment Date: Annual Salary: Employment Date: Annual Salary: $ $

Part C- Dependents Name Relationship D.O.B. Daycare (Y/N)? MM/DD/YY Y N MM/DD/YY Y N MM/DD/YY Y N MM/DD/YY Y N

Part D- Rental/Leasing Information (if NOT owner occupied) Address: City: State: ZIP:

Tenant Name: Monthly Rent: Month Last Paid: Date Lease Expires: $ MM/DD/YYYY

Hardship: Please explain briefly the reason for needing this service. 3 Qualifying Questions Yes/No Are you employed? Is your spouse employed?

If employed within the last two months, can you provide a letter of employment? Do you have a pay option arm/negative amortization loan? Can you afford at least an interest only payment? Have you made 12 monthly payments since the loans origination? Have you had a loan modification on this property within the last twelve months? Can you provide your last two months bank statements? Can you provide your last two months payroll stubs? Can you provide your two years W2's or 1099's or 1040 or P/L statement? Are you willing to sign a IRS form 4506-T (Request for Transcript of Tax Return)? Have you or anyone else on your behalf requested a loan modification within the last 12 months? Have you filed for bankruptcy within the last 24 months? If yes, was the bankruptcy discharged? If you have filed for bankruptcy, was the bankruptcy--- chapter 7 chapter 13 If you have filed for bankruptcy and it was discharged, what was the date of the discharge? (MM/DD/YYYY) How many people live in this household?

NOD: (Notice of Default) Yes or NO Date:______

NTS: (Notice of Trustee Sale) Yes or NO Date:______4 Mortgage Details - 1 Property Address:

Lender Account # Current Principal Balance $ Past Due Amount $ Monthly Payment (PITI) $ Current Interest Rate % Current Principal and Interest Payment $ Escrows paid in Monthly Mtg Pmt. Yes ______NO ______Insurance - Monthly $ Taxes - Monthly $ Loan Type – ARM, Fixed, HELOC Loan Terms (# of years) # of Months Past Due Current Property Value $ Trustee Sale Date (MM/DD/YYYY)

Mortgage Details - 2 Property Address:

Lender Account # Current Principal Balance $ Past Due Amount $ Monthly Payment (PITI) $ Current Interest Rate % Current Principal and Interest Payment $ Escrows paid in Monthly Mtg Pmt. Yes ______NO ______Insurance - Monthly $ Taxes - Monthly $ Loan Type – ARM, Fixed, HELOC Loan Terms (# of years) # of Months Past Due Current Property Value $ Trustee Sale Date (MM/DD/YYYY) 5

Lender Account # Current Principal Balance $ Past Due Amount $ Monthly Payment (PITI) $ Current Interest Rate % Current Principal and Interest Payment $ Escrows paid in Monthly Mtg Pmt. Yes ______NO ______Insurance - Monthly $ Taxes - Monthly $ Loan Type – ARM, Fixed, HELOC Loan Terms (# of years) # of Months Past Due Current Property Value $ Trustee Sale Date (MM/DD/YYYY) 6 Mortgage Details - 5 Property Address:

Lender Account # Current Principal Balance $ Past Due Amount $ Monthly Payment (PITI) $ Current Interest Rate % Current Principal and Interest Payment $ Escrows paid in Monthly Mtg Pmt. Yes ______NO ______Insurance - Monthly $ Taxes - Monthly $ Loan Type – ARM, Fixed, HELOC Loan Terms (# of years) # of Months Past Due Current Property Value $ Trustee Sale Date (MM/DD/YYYY) 7 Mortgage Details - 7 Property Address:

Lender Account # Current Principal Balance $ Past Due Amount $ Monthly Payment (PITI) $ Current Interest Rate % Current Principal and Interest Payment $ Escrows paid in Monthly Mtg Pmt. Yes ______NO ______Insurance - Monthly $ Taxes - Monthly $ Loan Type – ARM, Fixed, HELOC Loan Terms (# of years) # of Months Past Due Current Property Value $ Trustee Sale Date (MM/DD/YYYY) 8

Assets

Description Amount/Value Amount Owed Net Value Checking Account $ $ $ Savings Account $ $ $ 401K/IRA/Keogh Acct $ $ $ Other Cash $ $ $ Primary Residence $ $ $ Second Lien Amount $ $ $ Other Property $ $ $ Automobile 1 $ $ $ Automobile 2 $ $ $ Totals $ $ $

Monthly Income

Description Borrower Co - Borrower Total Gross Income $ $ $ 0.00 Overtime $ $ $ 0.00 Commissions/Bonuses $ $ $ 0.00 Rental Income $ $ $ 0.00 Miscellaneous Income $ $ $ 0.00 Less: Federal Inc Tax ($ ) ($ ) $ 0.00 State Income Tax ($ ) ($ ) $ 0.00 Other ($ ) ($ ) $ 0.00 Monthly Net Income $ 0.00 $ 0.00 $ 0.00

Salary income is based on 12 months average

Sign ______Date ______

Sign ______Date ______9

Monthly EXPENSES

Description of Expense Monthly Payment Account Balance In default Y/N

Automobile Loan 1 $ $ Y N Automobile Loan 2 $ $ Y N Boat $ $ Y N RV $ $ Y N Motor Cycle $ $ Y N Home Phone $ $ Y N Cell Phone $ $ Y N Internet $ $ Y N Cable/Satellite $ $ Y N Electric $ $ Y N Groceries $ $ Y N Natural Gas $ $ Y N Water $ $ Y N Heating Oil $ $ Y N Propane $ $ Y N Pet Expenses $ $ Y N Child Care $ $ Y N School Lunches $ $ Y N HOA Payments $ $ Y N Lawn Care Maintenance $ $ Y N Pool Care Maintenance $ $ Y N Trash Pick up $ $ Y N Gasoline for Vehicles $ $ Y N Medical/Dental Payments $ $ Y N Other Payments $ $ Y N

Credit Cards (Visa, MC, Sears) $ $ Y N

Credit Cards (Visa, MC, Sears) $ $ Y N 10

Credit Cards (Visa, MC, Sears) $ $ Y N

Credit Cards (Visa, MC, Sears) $ $ Y N Restaurants $ $ Y N Movies $ $ Y N Vacations $ $ Y N Health Insurance $ $ Y N Life Insurance $ $ Y N Car Insurance $ $ Y N Boat Insurance $ $ Y N RV Insurance $ $ Y N Home Owner Insurance $ $ Y N Federal Tax Lien Pmt $ $ Y N State Tax Lien Pmt $ $ Y N Total Expenses $ $

Discretionary Dollars $______

Sign ______Date ______

PLEASE FAX--- ONCE APPLICATION IS FULLY COMPLETED TO 480-240-1316. Please do not send by email due to security reasons. Email is not secure for private information unless data is encrypted.

Thank you, CFO appreciates your business!