Loan Modification

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BUDGET CALCULATOR

Your contact information

Your Name

Name of
Spouse or Co-Borrower

Street Address

City

State

* Zip *

Mobile Number

Mobile Number of
Spouse or Co-Borrower

Tell us about your loan

	1st Mortgage	2nd Mortgage
Name of Lender (who you pay)
Loan #
Interest Rate
Unpaid Principal Balance
Payment $
Type of loan Example: 5 year, interest only taken out in October 2004
Adjusting? Y N
Date of adjustment
Number of months behind

Your monthly expenses

Monthly Expenses

Monthly
Amt.

Income

Monthly
Amt.

Mortgage Payment

Net Salary
(after deductions)

Property Taxes
(if not included in Mtg.)

Monthly
Every 2 Weeks
Weekly

Homeowner’s Insurance
(if not included in Mtg.)

Gross Salary
(before deductions)

Association Fees

Monthly
Every 2 Weeks
Weekly

Other Mortgages

Spouse's Net Salary

Automobile Payment

Spouse's Gross Salary

Other Automobile
Loan Payment

Alimony/Child Support

Automobile Insurance

Disability

Gasoline

Pension/Retirement

Electricity

Rental Property

Gas

Other Income

Water/Sewage

Total Net Income

Garbage

Total Gross Income

Telephone

Total Expenses

Cell Phone

Net Difference +/-

Cable TV

Gross Difference +/-

Credit Cards (combined
Minimum payments)

Other Loans (Specify)

How Many People
in Household

Health Ins. (not deducted)

Dues/Memberships

Medical Bills (not insured)

Prescription Medications

Child Care

Alimony/Child Support

Tuitions

Food/Household

Other Expenses
(Please Specify)

Miscellaneous

Second Property
- 1st Mortgage

Second Property
- 2nd Mortgage

Third Property
- 1st Mortgage

Third Property
- 2nd Mortgage

*required item

Total Expenses & Balances