Axia Financial, LLC

Submission Form
Client Name(s) ____________________________________________________________________
Please Print
Address___________________________________________________________________________

Phone_____________________________ Email__________________________________________
Loans to Modify: Estimated Market Value $_______________
1st Mortgage Lender ______________ Loan Number _________________ Interest Rate __________%
2nd Mortgage Lender______________ Loan Number _________________ Interest Rate __________%
Basic Questions: Circle All That Apply:
What type of loan is the first Mortgage? Interest only Fixed Adjustable Option Arm
When is the loan set to adjust? Already has 1-2 months 3 months or more
Does the monthly mortgage payment include escrows? Yes No
Are they in foreclosure? Yes No
What was the date of filing? ___________________________________________
Did they receive an NOD letter? Yes No Date received ________________________________
Is there a “Notice of Sale”? Yes No
Do they occupy the property Yes No
Have they had the loan at least 1 year? Yes No
Are they currently behind on their mortgage? Yes No How many months behind? ______
Have they done a loan Modification or Rate freeze in the last 12 months? Yes No
Stacking order:
1. Submission form
2. Payment form/fee agreement
3. Mortgage statement 1st
4. Mortgage statement 2nd (if applicable)
5. Authorization to Release Information
6. Hardship letter (signed)
7. Financial Worksheet completed and signed by borrower
8. Blank Financial Worksheet signed by borrower
9. Last two years W2’s (if self employed need tax returns all pages)
10. Wage-earners - 2 current paycheck stubs
11. Tenant rent or other income (if applicable)
12. Bank statements (last three months)
13. Business bank statements (last three months if self employed)

Submitting Broker or Agent ___________________________Phone # __________________________