Thank you for sharing your story. The more precise and factual the information, the more help it will provide us for the purposes we are going to use this information for (discussion with regulators, policymakers). There is no intention to use actual names, etc.. so participants should feel free to provide the information requested as we may make some follow up calls. We are going to use the stories only when we take these cases to outside parties.

 
Your Name:
Company:
City:
State:
Zip Code:
Phone Number:
E-mail Address:
Today's Date:
Years In Business:
Types of Business:
(Please select all that apply):		 Single-Family
Multifamily
Commercial
Land Development
Other
Project Name:
Project Location:
Project Size:
(# of lots / units / homes):
Loan Amount Outstanding:
Appraised Value of Project:
Approximate Date of Most Recent Appraisal:
Lender Name and Location:
Is the loan current?: Yes No
Is the loan in foreclosure?: Yes No
Is the loan in the process of being sold?: Yes No
Other Loan Status Issues:
What problems are you encountering with this loan?
What actions have you taken to resolve the financing issue?
How has the lender responded to your efforts?
What needs to be done to resolve this issue?
Additional Comments: