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Shaw Real Estate Solutions

Online Application

First Name *
Last Name *
Spouse First Name
Spouse Last Name
Referred By
Address Line 1 *
Address Line 2
City *
State *
Zip *
Phone Number *
Alternate Phone Number
Primary Email *
Alternate Email *
Preferred Contact Method *PhoneEmail
Foreclosure Address Same As Contact Address *YesNo
Foreclosure Address Line 1 *
Foreclosure Address Line 2
Foreclosure City *
Foreclosure State *
Foreclosure Zip *
Employer *
Years on Current Job * Use months if necessary
Work Phone *
Part Time Employer
Years on Part Time Job Use months if necessary
Spouses Employer
Spouses Years on Job Use months if necessary
Spouses Work Phone
Spouses Part Time Employer
Spouses Years on Part Time Job Use months if necessary
Number of Dependents * Children or Adults in your home and under your care
Ages of Dependents * Just separate by commas
First Mortgage Lender *
Mortgage Loan Type *
Mortgage Loan Number *
Months Behind on Payments *
Second Mortgage Lender
Months Behind on Second Mortgage
Purchase Price of Property *
Remaining Balance * Amount owed on property
Date Purchased *
Market Value of Property
Name of Foreclosure Lawyer
Foreclosure Hearing Date
Foreclosure Sale Date
Detailed Reason Behind * Explain why you have fallen behind with your mortgage
Debtors Monthly Take Home Pay * Total of all jobs
Spouses Monthly Take Home Pay Total of all jobs
Other Monthly Income
Other Monthly Income Description
Est Avg Future Monthly Income
Cash on Hand for Negotiation
Rent of Home Mortgage Payment
Second Rent or Home Mortgage Payment
Electricity Bill
Heating Bill
Water Bill
Sanitation Bill
Telephone Bill Including Cell Phone
Food Expenses
Medical and Drug Expenses
Automobile Payment Total of all appllicable
Automobile Insurance Total of all appllicable
Cable TV Bill
Homeowners Insurance
Transportation Expense Fuel, maintenance, public transportation
Property Taxes
Alimony or Support Expenses
Child Care or Tuition Expenses
Clothing Expenses
Laundry and Cleaning Expenses
Religious or Charitable Contributions
Miscellaneous Creditors Total of any other expenses not covered previously
Chapter 13 Payments