Homeowner Information

Please enter your legal name and home address.

Your Legal First Name *

Please enter your first name.

Your Legal Middle Name *

Enter "N/A" if you do not have a middle name.

Your Legal Last Name *

Please enter your last name.

Address *

Please enter your address.

City *

Please enter your city.

State *

Please enter your state.

Postal Code *

Please enter your postal code.

County *

Please enter your county.

Homeowner Information

Personal identification and contact details.

Date of Birth *

Please enter your date of birth.

Social Security No. *

Please enter your SSN in NNN-NN-NNNN format.

Last 4 of Social Security No. *

Please enter the last 4 digits of your SSN.

Email *

Please enter a valid email address.

Phone *

Please enter your phone number.

Front & Back of Photo ID (Drivers License) *

⬆

Click or tap to upload

PNG, JPEG or JPG accepted

Please upload BOTH the Front AND Back of your Drivers License.

Please upload both front and back of your ID before continuing.

Lender Information

Tell us about your mortgage lender.

Your Lender *

Please enter your lender's name.

Your Lender's Street Address *

Please enter your lender's street address.

Your Lender's City *

Please enter your lender's city.

Your Lender's Phone

Mortgage Information

Details about your mortgage account.

Mortgage Total Arrears / Amount to Bring Mortgage Current *

This field is required.

Mortgage Loan Number *

Please enter your loan number.

Mortgage Acct - Website *

If you don't have access, please type "NA"

Please enter the website or type "NA".

Mortgage Acct - Login ID *

If you don't have access, please type "NA"

Please enter your login ID or type "NA".

Mortgage Acct - Password *

If you don't have access, please type "NA"

Please enter your password or type "NA".

Mortgage Acct - Access Authorization *

By checking this option, you Authorize Integrated Home Solutions to utilize the Username and Password you provided to Access and Obtain information and documents on your mortgage account on your mortgage lender's website.

You must authorize access to continue.

Business Information

Tell us about any business ownership in the past 8 years.

Have You Owned a Business in the Last 8 Years? *

Yes No

Please select an option.

What is/was the Name of Your Business?

What is/was Your Business EIN/TIN?

Are You the Sole Proprietor of Any Full/Part-Time Business? *

Yes No

Please select an option.

Sole Proprietor Business Name?

Sole Proprietor Business EIN/TIN

Bankruptcy Information

Please answer all questions honestly and completely.

Have You Filed Bankruptcy in the Last 8 Years? *

Yes No

Please select an option.

What is the Date of Your Last Bankruptcy? *

What City & State Did You File Your Last Bankruptcy In? *

Have You Filed Any Other Bankruptcy in the Last 3 Years? *

Yes No

Please select an option.

What is the Date You Filed that Other Bankruptcy? *

What City/State Did You File that Other Bankruptcy In? *

What is the Case Number for that Other Bankruptcy? (optional)

Do You Have a Bankruptcy Currently Pending That You Recently Filed? *

Yes No

Please select an option.

What is the Case Number for that Pending Bankruptcy? (optional)

What is the File Date for that Pending Bankruptcy? (optional)

What City/State Was that Pending Bankruptcy Filed In? *

Bankruptcy Information

Almost done — estimated financial picture and agreement.

What is the Estimated Amount of Your Total Assets? *

This is the Estimated Amount or Value of Everything You Own Outright

Please enter your estimated total assets.

What is the Estimated Amount of Your Total Liabilities? *

This is the Estimated Amount or Value of Everything You Owe (ex: Cars, Credit Cards etc.)

Please enter your estimated total liabilities.

Your information is Private & Secure. By completing this Application, I agree to Terms & Conditions and to receiving sms & email messages from Integrated Home Solutions regarding my Foreclosure Assistance request, and an occasional marketing messages. MSG & DATA Rates may apply.

You must agree to the Terms & Conditions to submit.

Welcome Back!

Homeowner Information

Homeowner Information

Lender Information

Mortgage Information

Business Information

Bankruptcy Information

Bankruptcy Information

Application Submitted!