Debt Analysis

This is the full application for our programs.

We can help you avoid foreclosure and assist you in stabilizing your financial situation through a variety of nationally recognized programs and reinstatement options to which we have direct access. We are experts at negotiating with the banks.

To begin, please complete the form below. Our expert staff will contact you with your free, no-obligation financial analysis and discuss program qualifications with you.

Personal Contact Information
*Your Name:
Spouse or Co-Borrower's Name:
*Your Address:
*City, State, Zip:
*Daytime Phone:
*Evening Phone:
Cell Phone:
*E-Mail Address:
Your Mortgage Payments
*1st Monthly Mortgage Payment:		2nd Monthly Mortgage Payment:
*Are you currently behind on any mortgage payments?
If yes, how many payments have you missed?	1st Mortgage:		2nd Mortgage:
Your Auto Loans
1st Auto Loan Payment:		2nd Auto Loan Payment:
*Are you currently behind on any auto loan payments?
If yes, how many payments have you missed?	1st Auto:		2nd Auto:
Your Other Loans
*Credit Card Monthly Payments (combined):	$
*Are you currently behind on any credit card payments?
Payday or Cash Advance Loan Payments:	$
Other Payments
Monthly Auto Insurance Expenses:	$
Monthly Life Insurance Expenses:	$
Total Past Due IRS or State Taxes:	$
Monthly Household Income
*Your Monthly Gross Income:	$
Spouse or Co-Borrower's Monthly Gross Income:	$

I hereby authorize the release of this information to Fresh Start Corporation and its debt analysis associates only, and therefore do not authorize the release of this information to any other person, person(s), corporation, entity or otherwise.

A red asterisk * indicates a required field.

Debt Analysis

Personal Contact Information

Your Mortgage Payments

Your Auto Loans

Your Other Loans

Other Payments

Monthly Household Income