Call in form Use this form to qualify mortgage callers for credit repair. The form results will be emailed to you. Incoming Call Script If you are human, leave this field blank. Thanks for calling the mortgage center. How are you today? Allow me to ask a few questions and I can help you get started ok? First Name * May I have your first and last name. Last Name Are you calling to purchase or refinance a home? Loan Purpose * Purchase Refinance Home Equity Loan Construction Stop Foreclosure Is this the best number to reach you on? Home Phone Number Is that a mobile phone? Cell Phone Number (10 digits) State where the property is located State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Current Zip Code * Property Type * Single Family and up to 4 units Multi-Family Commercial Mobile Home Condominium Have you already found a house? Yes No Do you want to get help to find a house? Yes No Combined Annual Income What is the property value or price range? How much do you owe or want to borrow? Now I will ask about your credit history Please answer yes or no. Do you have any ____? * Collections or Late payments Repossession or Foreclosure Bankruptcy or Judgements Liens or Levies None of the above Do you know your credit score? * Poor 619 or below Fair 620 - 669 Good 670 - 739 Excellent 740 + unknown May I have your email address? I will have someone call you back to go over your options to stop foreclosure. Based on everything you said, you can qualify except you need to get those negative items removed from your credit report. Do you want help to do that? Yes No After the foreclosure problem is solved, do you want to get it removed from your credit report? * Yes No If yes, say "We will contact you later to solve that problem." We recommend_____________to remove those negative items from your credit report. We have worked with them for 7 years and they have helped thousands of our customers. Is it OK if I transfer you so they can explain how the process works? OK Hold on for a moment and I will introduce you. It may take up to three minutes, so please hang on while I introduce you OK? (Dial ##*18552550269# and wait for the agent to answer, then say "This is ____operator #____, I have _______ on the line that needs help removing ______from their credit report. The phone number is ________. Go ahead please". Hang up. What should we do with this lead? * Submit it to leads.mortgageleads.net database Email me this lead and post it to leads.mortgageleads.net Email me this info and keep it private comments Your Email Address (Where to send this info) Put your email address here if you want a copy of this lead.