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Free Information Request Form Privacy Notice:  The information provided to Arizona Foreclosure Counseling is strictly for the use of providing assistance to Phoenix, Arizona home owners.  It will be forwarded to Foreclosure Help Group who is experienced in assisting home owners with possible foreclosure prevention options.  By filling the form out below, you are not soliciting the services of an agent, unless indicated by you. The information provided will not be sold, shared or shown to other individuals, entities, or companies without the consent of the person below. See Privacy Statement for more information.  Use the following form to request free, confidential assistance to avoid foreclosure, to receive free information on alternatives to foreclosure, to qualify for foreclosure assistance, and/or to request a one-on-one counseling session about your situation. If you wish to speak with a foreclosure counselor immediately CALL 602-626-3598. Your Contact Information First Name(s) Day Phone Last Name Evening Phone Email Cell/Pager (If you do not have an Email address, enter "none".) Best Time to Call Anytime Morning Afternoon Evening Night How did you hear about us? Search Engine Craigslist Back Page AZ Republic New Times Friend / Family Other PostCard Letter Backpage Your Property Information Address City State AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MA MD MI MN MS MO MT NE NV NC NH NJ NM NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip County How long have you owned this house? What is the current condition of your property? Excellent Good Fair Poor Terrible What kind of repairs and maintenance does the house need? How much do you think these repairs will cost? $ Is there anyone living in the house?    Yes - Owner Occupied Yes - Tenant No - Unoccupied Is the house currently listed with a ®Realtor? Yes  No          If Yes, when does the listing expire?              If No, has the house been previously listed? Yes  No Do you have any questions or comments you would like to share with us? Mortgage/Lien Information 1st lien Amount? 2nd lien Amount? Other lien Amounts? Approximate Home Value ? Months Behind? C O N F I D E N T I A L Thank you for taking the time to share your information about your home with us.We will review your information and contact you shortly. If you have any problem submitting this form, please contact us and let us know.

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