Anda di halaman 1dari 38

Twin Builders Foundation Corp

1010 North Central Avenue, Glendale, CA 91202
Tel. No. 1‐888‐777‐9489 Fax No. 1‐(888) 755‐1416

INTAKE CHECKLIST/FAX COVER
Manager's Name   Date:
Coordinator's Name
Sponsor's Name
Client's Name:
Subject Property:
Required Documents:
Initial Documents
1.  Client Registration Form w/ Signature on 2nd page DONE
2.  Class Action Lawyer Retainer Agreement ‐ Signed DONE
3.  TBFC Donation Agreement DONE
4.  NOAH Membership Agreement DONE
5.  Copy of Closing Documents of Mortgage (1st and 2nd Lien Scanned or faxed) DONE
6.  Donation  Cashier's Check Set‐up of Service DONE
7.   Copy of all statement, communications, and notices from the Servicing Company DONE
8.  A chronological story line of the borrower with the lender and their representative. DONE
9. Authorization For Release Of Financial Records And Information DONE
10. TBFC Initial Intake Questionnaire DONE
11. Qualified Written Request To Be Sent To Your Lender DONE
12. Financial Worksheet DONE
13. TBFC Disclaimer on the Use of Legal Templates DONE
14.  Postdated Checks Covering The Monthly Future Payments DONE
Additional Information:

___________________________
Intake Center/Date
Twin Builders Foundation Corp
NOAH-CENTRAL
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-(888) 755-1416

Client Registration Form Preliminary Request


Agent Information: Agent Code #
Name: Phone: Fax:
Email:

Borrower Information
First Name: Last Name: SSN: (Last 4 Digits)
Co-Borrower Information
First Name: Last Name: SSN: (Last 4 Digits)
Subject Property Address: E-Mail Address
City: State: Zip:
Mailing Address:
City: State: Zip:
Hm Phone: Wk Phone: Cell Phone:

Number of Lien Holder(s): (Check One)


1st Mtg 2nd Mtg 1st & 2nd Mtg (Same Lender) 1st & 2nd Mtg (Diff. Lender)

p y Value:
Property
Occupancy: Property Type:
O/O 2nd Hm N/O/O SFR Condo Twn hm(PUD) Multi:___Unit

First Mortgage Information


Lender: Loan #: Balance:
Interest Rate: Payment: Mtg type:
Months Delinquent: Yr Acq'd/Last Refi'd: Impounds: Y N

Second Mortgage Information


Lender: Loan #: Balance:
Interest Rate: Payment: Mtg type:
Months Delinquent: Yr Acq'd/Last Refi'd: Impounds: Y N

Pre-Qual Validation (Check each item that applies)


Client has received an NOD or foreclosure summons on the property ____________(date rec'd)
Client is in active Bankruptcy or in active Bankruptcy hearings
Foreclosure proceedings have started _____________________ (date)
An Auction Date has been set for ___________________(sale date)
Client is in a Negative Amortization Loan, and is seeking a lower and/or fixed rate/payment
Client is unemployed
Within the 12 months, client has been offered or accepted a forebearance or loan modification
Client's current mortgage payment ALONE is higher than combined household income
Client is currently applying or has applied for a loan modification with client's bank
Client is within 15 days of an auction sales date
Client owns additional properties
Clients is in behind on their mortgage payments

Additional Notes:
Borrower's Employment Information

Employer Name:

Employer Address:
City State ZIP Code
Employer Telephone Number ( )
Gross
Job Title How Long? Income:

Co-Borrower's Employment Information

Employer Name:

Employer Address:
City State ZIP Code
Employer Telephone Number ( )
Gross
Job Title How Long? Income:

Required Documents Needed For Preliminary Review

1. Latest Mortgage Statement and Closing Docs on all mortgages (1st and 2nd)

2. Latest document or communication from your lenders (default or foreclosure notices)

Payment Checklist Set-Up Donation 5 Post Dated Check

Which type of payment will you use to pay for this service (Check One)
Money Order Cashier's Check

I / We declare under the penalty of perjury under the laws of the State of ___________
that the foregoing information is true and correct.

Borrower Signature Borrower Name Date

Co-Borrower Signature Co-Borrower Name Date

Please fax with the completed Membership Service Agreement


and supporting documents requested above to 1 (888) 755-1416
e-mail
Or e mail to intake@builder4u.org. Thank you.
The Law Office of DICKSON & ASSOCIATES
ATTORNEY-CLIENT CONTINGENCY FEE AGREEMENT
The Law Office of ROY CHESTER DICKSON (collectively with any lawyers we affiliate with or engage to work with
us on your matter, “Attorney”, “we” or “us”) and the individual or individuals who sign this agreement on the last
page (“Client” or “you”) hereby agree that Attorney will provide legal Services to Client on the terms set forth below.

The contact information for Attorney is:


ROY CHESTER DICKSON
DICKSON & ASSOCIATES
2323 N. Tustin Avenue Suite I, Santa Ana, CA 92705
Email: lawsuit@homeownersclassaction.org
Tel: 1-888-777-9489 Fax: 1-888-503-2119

1. CONDITIONS

a. A Class Action Lawsuit that you are requesting to participate in is currently being created against
Mortgage Electronic Registration Systems, Inc. and Other Lenders. It is possible that the new
lawsuits ultimately will be consolidated with other similar cases and it is possible that there will end up
being several similar lawsuits, including, among others, the lawsuit in which you are named as a
plaintiff.

b. To simplify this Agreement, the new lawsuit in which you will be a plaintiff, any other similar or related
lawsuits we previously commenced or may hereafter commence, and any consolidation of any of these
lawsuits is collectively referred to in this Agreement as “Lawsuit”.

c. This lawsuit will be filed in State Court and Client acknowledges and agrees that Client may
seek damages of more than $50,000 in the lawsuit, to the extent that Client has a basis to do so.
Without limiting anything in this Agreement, regardless of the amount of damages sought by
Client, Attorney does not guarantee and could not guarantee that Client will receive the amount
of damages, or any damages. Attorney and Client may lose the case in which event Client likely
would receive nothing. Attorney does not guarantee the Lawsuit will not be transferred to
another court.

d. This Agreement will not take effect, and Attorney will have no obligation to provide legal Services (as
defined in Paragraph 2, below,) until Attorney decides to add Client as a plaintiff in the new Lawsuit
AND Client returns a signed copy of this Agreement to Attorney, whether in person, by fax (entire
Agreement, including signature page) to 1-888-503-2119 or by scanning the entire Agreement,
including signature page into a PDF and email it to lawsuit@homeownersclassaction.com. Attorney
shall have sole discretion whether or not to add Client as a plaintiff in Court.

e. Client understands and agrees that Client is and will be part of a group of persons (and potential
plaintiffs in the Lawsuit) with similar, but perhaps not identical claims to Client. This situation is
discussed further below in this Agreement. As a result of there being a group of persons, we may
request Client to enter into a certain “riders”, “amendments” or “addendums” to this Agreement as the
matters proceed and in order to protect all persons who become plaintiffs in the Lawsuit. Client agrees

_____________ (Client Initial Here)

 
in good faith to consider these “riders,” “amendments” and “addendums”. If Client declines to sign any
such riders, amendments or addendums, Attorney may not be able to include Client in the Lawsuit.

2. SCOPE OF SERVICES.

a. Client is hiring Attorney to represent Client in the matter of Client’s claims against Mortgage
Electronic Registrations Systems Inc. and possibly related companies and individuals. All such
companies and individuals are collectively referred to in this Agreement as “Lenders”.

b. The scope of the matters to which Attorney’s services pertain is meant to be read in the broadest
possible sense and would include any matters relating to any subsidiary, successor or affiliate of
Lenders; thus, Client would be permitted hereunder to access our services in any such matter to be
read in the most expansive definition of what is or is not related to Lenders so long as it pertains to this
matter, this broad range of services shall be referred to hereinafter as “Services”. If a court action is
filed, Attorney will represent Client until a settlement or judgment, by way of arbitration or trial, is
reached. Attorney will oppose any motion for a new trial or any other post-trial motions filed by an
opposing party, or will make any appropriate post-trial motions on Client’s behalf.

c. Notwithstanding anything to the contrary in this Agreement: (i) the Services do not include assistance
with respect to seeking injunctive or other immediate relief with respect to a foreclosure or eviction,
provided that (ii) if Attorney agrees to assist in the foregoing, Attorney will be entitled to seek an award
of attorney fees from the Lenders for doing so and such fees will be in addition to any compensation
provided below in this Agreement for the Services.

d. After judgment, Attorney will not represent Client on any appeal, or in any proceeding to execute on the
judgment, unless Client and Attorney agree that Attorney will provide such Services and also agree
upon additional fees, if any, to be paid to Attorney for such Services. Services in any matter not
described above will require a separate written agreement.

3. RESPONSIBILITIES OF THE PARTIES; CONFLICTS.

a. Attorney will provide those legal Services reasonably required to represent Client in prosecuting the
claims described in Paragraph 2 and will take reasonable steps to keep Client informed of progress
and developments. Because there are many plaintiffs. However, when issues specific to your case
arise, Attorney will communicate directly with you. Client agrees to be truthful with Attorney, to
cooperate, to keep Attorney informed of any information and developments which may come to Client’s
attention, and to keep Attorney advised of Client’s address, telephone number and whereabouts.
Client agrees to appear at all legal proceedings when Attorney deems it necessary, and generally to
cooperate fully with Attorney in all matters related to the preparation and presentation of Client’s
claims.

b. Notwithstanding the foregoing, to a great degree, our relationship with Client as Client’s attorney is
governed by both this Agreement and the California Rules of Professional Conduct. The entire text of
the Rules of Professional Conduct can be found at http://calbar.ca.gov/calbar/pdfs/rules/Rules
Professional-Conduct.pdf

_____________ (Client Initial Here)

 
c. Of particular importance is Section 3-310 of the California Rules of Professional Conduct, quoted
below; we have informed you that we may undertake representation of numerous Clients similarly
situated. These clients may all have a unique fact pattern: They may have had their private information
stolen; they may have had their identities stolen; they may have fallen victim to unfair business
practices by the Lenders; or they may have had each of the foregoing circumstances – or any one of
them – happen. Under Section 3-310, it is theoretically and in fact possible that our representation of
each of the Clients may result in a conflict of interest which must be disclosed and waived by each of
the Clients. The conflict of interests could be many, but the primary one revolves around the possibility
that we may not – in our prosecution of your legal rights – obtain enough money or consideration to
make each of the Clients feel as if they were made whole. In this regard, Section 3-310 provides,
among other things.
(B) A member shall not concurrently represent clients whose interests conflict, except with their
informed written consent.

(C) A member who represents two or more clients shall not enter into an aggregate settlement of the
claims of or against the clients, except with their informed written consent.

(F) As used in this rule “informed” means full disclosure to the client of the circumstances and advice
to the client of any actual or reasonably foreseeable adverse effects of those circumstances upon
the representation.

d. By signing this Agreement, you understand that we may have closer relationships with certain clients
than with other clients, that each Client we represent has been damaged in differing ways and in
varying amounts, that not every Client will be satisfied with any settlement or result we achieve, that we
must apportion any result so as to do substantial justice for all of the Clients, and that this involves
judgment on our part. We will exercise our judgment fairly and in good faith.

e. Notwithstanding these facts, you understand and acknowledge (i) that we have fully explained to you
the process of apportioning settlements or results against the Lenders, (ii) you submit to any process
that is fair and lawful, (iii) you understand the process may result in our representing conflicting
interests and (iv) you now, and forever, hereby consent to our representing these conflicting interests
among the Clients and you waive – from now until forever – any rights under Section 3-310 and any
similar law in any jurisdiction in the United States.

4. LEGAL FEES.

a. Attorney will only be compensated for legal Services rendered if a recovery is obtained for Client. Client
will not pay Attorney any funds at all for Attorney representation of Client in the matters, and Client shall not
be responsible for paying Attorney any money to reimburse Attorney for costs incurred in such litigation.
The following sets for the fee payable by Client to attorney, which is customarily referred to as a
“contingency fee”.

(1) Attorney shall receive a sum equal to forty percent (40%) of the “gross recovery” pertaining to
Client.

_____________ (Client Initial Here)

 
(2) For purposes of this Agreement, the term “gross recover” means the greater of the following
sums: (i) any recovery, judgment or order to pay money to you or any party affiliated with you or
acting on your behalf, that is ordered by a court of competent jurisdiction in the litigation or in
connection with the Services, including, but not limited to, compensatory damages, punitive
damages, treble damages, restitution, all other damages and forms of judicially ordered
remuneration, interest, assessments, sanctions and any other monies ordered by such a court in
connection with the litigation, and (ii) any money or consideration actually received by you
appertaining in any manner to the matters and/or the Services and/or the litigation, whether that
sum is received by reason of negotiated settlement, mediation, arbitration, jury award, judge award
or otherwise.

b. To the extent Attorney prevails in the Lawsuit on Client’s behalf, Client agrees that Attorney may apply to
the Court for an order that the defendants in the Lawsuit shall pay the Client’s legal fees. There can be no
assurance such an order will be issued, or that the full amount of Client’s fees will be paid by the
defendants. In any event, if the court orders the defendants to pay all or any portion of Client’s Attorney
fees, Attorney is directed to apply any such award of attorney’s fees in an ethical manner to reduce Client’s
obligations hereunder by the amount of the award. In the alternative, in the Attorney’s discretion, Attorney
may replace in whole the contingency fee due hereunder by accepting the attorney fees paid by the
defendants.

c. The payment of fees under this Paragraph 4 is irrevocable and shall be paid irrespective of any other facts
whatsoever, including, without limitation, the amount of work requested by Client and the amount of work
performed by Attorney as a result thereof. All proceeds of Client’s case are non-refundable and non-
creditable, fully earned upon receipt by Attorney. Attorney will pay to Client the share payable to Client
after first deducting Attorney’s fees and costs from all gross recoveries.

5. NEGOTIABILITY OF FEES.

The fees set forth above not set by law, but are negotiable between an Attorney and Client. The foregoing
“contingency” related fees have been arrived at through careful negotiations that included consideration of factors
well beyond the amount of time spent and to be spent hereunder, including, without limitation, the novelty and
complexity of numerous issues in the matters at hand, the amount of fees, costs and expenses Attorney is
anticipated to be actually incurring in connection with any litigation, our familiarity with certain specific areas of law
on a variety of issues and topics, the addition of lawyers to work with Attorney who will be compensated by Attorney
out of the contingency fee, or otherwise, at no cost to Client, the preclusion of other engagements and opportunities
caused by our acceptance of this engagement and Agreement, the magnitude of the Services as Client has
described it, Client’s strong desire to have us personally perform the Services hereunder, and other considerations.

6. COSTS AND LITIGATION EXPENSES.

a. In connection with any litigation, there will be significant costs that will be incurred by Attorney hereunder.
These costs may include the following: Travel expenses, facsimile charges (at 10 cents per page), filing
fees, service or investigative fees, expert fees, jury fees, court fees, record securement, deposition fees,
trial costs, parking, postage, photocopying expenses (at 25 cents per page), phone charges and other
standard costs. While Client is not responsible to pay Attorney for these costs, or for any costs. Client
agrees that we are entitled to deduct and take a full reimbursement for all such costs in the event of an
_____________ (Client Initial Here)

 
award as first money out. In certain circumstances connected to an award, we will be entitled to obtain a
separate order of repayment from the defendants or adversaries in the litigation to reimburse some or all of
the costs. We agree to use our best efforts to do so.

b. Although we may deduct the fees and costs paid to paralegals and clerks who assist us in this case, we will
absorb out of our fees and share our fees with other lawyers who affiliate in with us or otherwise participate
with us to represent you. Such lawyers are considered to be within the definition of Attorney for purposes
of this Agreement. However, unless the signatories to this Agreement advise you otherwise, your principal
relationship will be with the undersigned and the undersigned will be responsible, on your behalf, for
coordination with any other lawyers we bring into the matters to work with us.

7. NO BILLING STATEMENTS.

Attorney will not send Client statements regarding the services rendered hereunder.

8. APPROVAL NECESSARY FOR SETTLEMENT.

Attorney will not make any settlement or compromise of any nature of any of Client’s claims without Client’s prior
approval. Client retains the absolute right to accept or reject any settlement. Client agrees to consider seriously
any settlement offer Attorney recommends before making a decision to accept or reject such offer. Client agrees
not to make any settlement or compromise of any nature of any of Client’s claims without prior notice to Attorney.

9. LIMITATION OF REPRESENTATION

Attorney is representing Client only on the matter described in Paragraph 2. Attorney’s representation does not
include independent or related matters that may arise, including, among other things, claims for property damage,
workers’ compensation, disputes with a health care provider about the amount owed for their Services, or claims for
reimbursement (subrogation) by any insurance company for benefits paid under an insurance policy. This
Agreement also does not include defending Client against, or representing Client in any claims that may be
asserted against Client as a cross-claim or counter-claim in Client’s case. This Agreement does not apply to any
other legal matters. If any such matters arise later, Attorney and Client will either negotiate a separate agreement if
Client and Attorney agree that Attorney will perform such additional legal work or Client will engage separate
counsel with respect to the cross-claim or counter-claim or additional legal work. Some lawyers working on this
case do not carry professional indemnity insurance.

10. DISCHARGE AND WITHDRAWAL.

a. Client may discharge Attorney at any time, upon written notice to Attorney. Attorney may withdraw from
representation of Client (i) with Client’s consent, (ii) upon court approval, or (iii) if no court action has been
filed, for good cause and upon reasonable notice to Client. Good cause includes Client’s breach of this
contract, Client’s refusal to cooperate with Attorney or to follow Attorney’s advice on a material matter, or
any other fact or circumstance that would render Attorney’s continuing representation unlawful or unethical.
Notwithstanding Attorney’s withdrawal or Client’s notice of discharge, and without regard to the reasons for
the withdrawal or discharge, Client will pay Attorney for all costs incurred prior to the termination and, in the
event that there is any gross recovery obtained by Client after conclusion of Attorney’s Services, Client

_____________ (Client Initial Here)

 
remains obligated to pay Attorney for the reasonable value of all Services rendered from the effective date
of this Agreement to the date of discharge.

b. If Attorney is discharged or resigns, the fee to which Attorney is entitled shall be not less than one-half of
the contingency fee described above in Paragraph 4, nor more than the foregoing percentage fees and will
be determined by considering the period until the discharge and the materiality of the contribution of
Attorney to the gross recovery obtained by Client. In the event the gross recovery has been sustainably
arrived at prior to the discharge, or is equal to or less than a settlement rejected by Client, Attorney will
receive the full contingency fee described above.

11. CONCLUSION OF SERVICES.

When Attorney’s Services conclude, all unpaid charges will immediately become due and payable. After Attorney’s
Services conclude, upon request, Client’s file and property will be delivered to Client, or Client’s other attorney,
whether or not Client has paid any fees and/or costs owed to Attorney.

12. LIEN.

Client hereby grants Attorney a lien on any and all claims or causes of action that are the subject of Attorney’s
representation under this Agreement. Attorney’s lien will be for any sums owing to Attorney for any unpaid costs, or
attorneys’ fees, at the conclusion of Attorneys Services. The lien will attach to any gross recovery, whether
obtained by arbitration award, judgment, settlement or otherwise. The effect of such a lien is that Attorney may be
able to compel payment of fees and costs from any such funds recovered on behalf of Client even if Attorney has
been discharged before the end of the case. Because a lien may affect Client’s property rights, Client may seek the
advice of an independent lawyer of Client’s own choice before agreeing to such a lien. By initialing this paragraph,
Client represents and agrees that Client has had a reasonable opportunity to consult such an independent lawyer
and whether or not Client has chosen to consult such an independent lawyer. Client agrees that Attorney will have
a lien as specified above. Attorney shall further have the right to receive and negotiate any check, draft or cashier’s
check constituting the proceeds of any payment, settlement sum, or judgment amount may retain therefrom any
and all fees and expenses due to Attorney hereunder. Attorney will deposit such sums in Attorney’s trust account
and thereafter will pay to Client the amounts payable to Client hereunder. This Agreement shall act as a power of
attorney to negotiate any draft, receive any wire transfer, check, cashier’s check or other negotiable instrument
offered as payment to Client. All payments are due in the manner set forth herein and Client agrees to pay
prejudgment interest at the legal rate in the event that we are compelled to take action to collect any unpaid sums.

13. DISCLAIMER OF GUARANTEE

a. Nothing in this Agreement and nothing in Attorney’s statements to Client will be construed as a promise or
guarantee about the outcome of this matter. Attorney makes no such promise or guarantees. There can
be no assurance that Client will recover any sum in this matter, or obtain any other relief. Attorney’s
comments about the outcome of this matter are expressions of opinion only. Client acknowledges that
Attorney has made no promise or guarantees about the outcome. Rather, Client agrees that any statement
Attorney has made in the past or do make in the future constitutes a good faith expression of opinion, is
tentative, and is not promissory.

_____________ (Client Initial Here)

 
b. Attorney opinions are guarantees and are subject to revision as matters within the area of our Services may
develop or change, or more facts may become known or available.

c. In addition to the Client’s waiver of conflicts of interests as set forth above, (i) each Client’s case is different,
(ii) thus, certain Clients who become plaintiffs may be successful in the prosecution of the Lawsuit and
others will not. That is one of the reasons it is very important that Client be completely forthright with us, or
we will have the right to withdraw from representing Client for “good cause” in that if Client is not forthright it
wastes our time, subjects us to attack in court and could hurt the other persons in the group.

d. The areas in this case are new law, changing law and thus it is impossible for lawyers to predict the future
pathway for Client and indeed new law is coming down virtually monthly. Client may wish to become a
plaintiff in the Lawsuit. However, Attorney has the right to decline to proceed. If Attorney does name Client
as a plaintiff, in the Lawsuit Client recognizes and understands that Client may nonetheless lose Client’s
claims in the Lawsuit, even if other plaintiffs prevail.

14. ENTIRE AGREEMENT.

This Agreement constitutes the entire agreement between the parties pertaining to the subject matter contained
herein and supersedes all prior and contemporaneous agreements, representations and understandings – whether
oral, written or both – of the parties with respect to the subject matter hereof. There have been no prior or
contemporaneous agreements, representations and understandings between the parties and the only agreement
that formed the topic of negotiations and discussions is contained herein. No other agreement, statement or
compromise made on or before the effective date of this Agreement will be binding on the parties.

15. SEVERABILITY IN EVENT OF PARTIAL INVALIDITY.

If any provision of this Agreement is held in whole or in part to be unenforceable for any reason, the remainder of
that provision and of the entire Agreement will be severable and remain in effect. To the extent any person
attempts to, or does in fact, strike any portion of this Agreement, nothing thereby shall preclude a court of
competent jurisdiction from rendering an award of legal fees to Attorney based upon doctrines of law such as
quantum meruit.

16. MODIFICATION BY SUBSEQUENT AGREEMENT.

This Agreement may be modified by subsequent agreement of the parties only by an instrument in writing signed by
both of them or an oral agreement only to the extent that the parties carry it out. Accordingly, this Agreement may
not be so modified by a writing that is unsigned by one or both of the parties hereto and it may not be modified by
any oral amendment, oral agreement or other oral modification. In fact, any oral amendment or written modification
that remains unsigned by both parties is invalid in that parties intent that there is no consideration for any future
promises that are not contained in writing and the parties specifically wish that this be the case.

17. EFFECTIVE DATE

This Agreement will govern all legal Services performed by Attorney on behalf of Client commencing with the date
Attorney first performed Services. The date at the beginning of the Agreement is for reference only. Even if this

_____________ (Client Initial Here)

 
Agreement does not take effect, Client will be obligated to pay Attorney the reasonable value of any Services
Attorney may have performed for Client.

18. GOVERNING LAW; OTHER JURISDICTIONS.

This Agreement, governing a relationship with a California-licensed lawyer, is governed by California law.

19. APPROVALS.

All parties hereto acknowledge, recite, stipulate and agree that they have received all approvals necessary under
fact or law for them to execute this Agreement and enter into this attorney-client relationship.

This Agreement is a binding legal document with significant consequences. All parties hereto stipulate
and recite that they have been advised by separate counsel with regard to the advisability of entering into
this Agreement.

IF MORE THAN ONE CLIENT SIGNS BELOW, EACH AGREES TO BE LIABLE JOINTLY AND SEVERALLY FOR
ALL OBLIGATIONS UNDER THIS AGREEMENT. THE CLIENT SHALL RECEIVE A FULLY EXECUTED
DUPLICATE OF THIS AGREEMENT.

Sincerely,

ROY CHESTER DICKSON

By:

For the Law Office of DICKSON & ASSOCIATES

THE FOREGOING IS AGREED TO AND IS ACCEPTED:

(sign name)
Print Name:

(sign name)
Print Name:

Client’s Address:

Client’s Facsimile:
Client’s Telephone:
Client’s Mobile:
Client’s E-mail:
_____________ (Client Initial Here)

 
Tw
wins Buiilders Fo
oundatio
on Corp
poration
1010 North Central Avenue,
A Glendale, CA 91202

Tel: 1--888-777-9489 Fax: 1--888-755-14


416

http://ww
ww.builder4u
u.org

DONATIO
ON AGREEM
MENT

1. PU
URPOSES FOR
F WHICH
H THE SER
RVICE OF TWINS
T BUIILDERS FO
OUNDATION
N
COR RP. IS ENGA
AGED

This Agreement was


w entered into in Glenndale, Califoornia, betweeen
, herein after
a to as NOAH
N MEEMBER, and the Twinns
Buildders Foundaation Corp., hereinafter referred too as SERVICE, on the date writteen
beloww.

1. NOAH H MEMBER R hereby suupports SER RVICE to assist


a NOAH H
MEMBER R in their collecting,
c orrganizing, and
a maintenaance of thesse documentts
that will be
b pertinent and needed by the legall team in purrsuing the leegal option of
o
NOAH MEMBERS;
M

2. NOAH H MEMBER R support SERVICE to coordinnate inquiryy,


research, consolidatioon of all resuults, and maiintenance off documents in support of
o
NOAH MEMBERS
M proactive effort
e towardds the legall and financial wellnesss
process;

3. NOAH H MEMBE ER support SERVICE E in coorddinating annd


engaging legal practittioners, expeert witnessess, and forenssic auditors from all oveer
the countrry in supportt of the legall initiative inn every statee;

4. NOAH H MEMBER R support SE ERVICE to package


p theirr capability in
i
servicing an interim private finanncing from investment partners of SERVICE in i
providingg existing lennder the gracceful exit.

5. NOAH H MEMBER R support SERVICE


S inn organizingg, equippingg,
and sustaiining local NOAH
N Chappter who willl support the long term financial annd
legal welll-being of thhe NOAH MEEMBER.

2. TE
ERMS AND AMOUNTS S OF FEES
NOA AH MEMBE ER agrees too donate to SERVICE for the abovvementionedd tasks to be
b
rendeered as follow
ws:

1. NOAH H MEMBER R will donatee to SERVIC CE an Initiall set-up fee in


i
the amounnt of One Thhousand Fivee Hundred Dollars
D ($1,5500.00);

Noah Member ___
______________  TBFC _____________
Tw
wins Buiilders Fo
oundatio
on Corp
poration
1010 North Central Avenue,
A Glendale, CA 91202

Tel: 1--888-777-9489 Fax: 1--888-755-14


416

http://ww
ww.builder4u
u.org

(b) NOA AH MEMBE ER will issuue to SERV VICE as a Sustaining Fee for thhe
aboveementioned tasks, Five Thousand Dollars
D ($5,0000.00) thereafter whichh is made thhe
form of Five (5)) postdated checks
c payaable to, datedd every 1st of the succeeeding montth
amouunting to On
ne Thousand Dollars ($1,000.00). This
T should be b issued upon signing of o
this Donation
D Ag
greement.

(c) This fee does not n include the legal representatio


r on of indiviidual NOAH H
MEM MBER in any y court of competent juurisdiction, nor
n in any addministrativee proceedingg,
prooff of service of documeents, processing of Lis Pendens, or o any other jurisdictioon
comppetent to adjudicate NOA AH MEMB BER’s compllaint, nor thee individuall appointmennt
or leggal advice inndividually rendered
r to NOAH
N MEM MBER by anny of our leggal counsel on
o
the sppecific issuees raised in thhe outcome of the legal research.
r

(d) If NOAH MEMBER desires additional


a seervices from
m SERVICE arising out of o
the reesearch of Chain
C of Tiitle or Forennsic Report (above andd beyond meere documennt
prepaaration), SE
ERVICE and NOAH MEMBER M can enter into a sepaarate writteen
agreeement for tho
ose additionnal services. Any additiional servicees rendered byb SERVICE
can only
o be pursu
uant to the separate
s writtten agreemeent, and any fee shall bee agreed to by
b
SERV VICE and NOAH
N MEM MBER under the separate written agreeement.

3. DEESCRIPTION N OF WOR RK TO BE COVERED


Timee devoted to o the NOAH H MEMBER R’s research of Chain off Title and Forensic wiill
include gathering g informatioon for incluusion into thhe documentt, documentt preparationn,
15US SC sec. 164 41(f)(2) from
m letter, connsultation with
w NOAH MEMBER to ensure all a
informmation incluuded in the form letter is accurate and correct, and any finnal documennt
prepaaration neceessary to ennsure that NOAH
N MEMMBER’s ressearch of Chhain of Titlle
compplies with thhe appropriatte procedurees of whicheever adjudicative body is
i responsiblle
for addjudicating NOAH
N MEMMBER’s form m letter.

4. FE
EE INCREASES
The above
a fees for
fo the researrch of Chainn of Title preeparation aree subject to increase
i as of
o
st
Januaary 1 of each year. NOAH N ME EMBER willl be notifiedd of any suuch proposeed
increase no laterr than thirty days prior to increase and, if no objection is made to thhe
increase, NOAH MEMBER will w be deem med to have agreed
a to thee increase.

5. CL
LIENT’S RE ESPONSIBIL LITY TO PA AY FEES
NOA AH MEMBE ER understannds that NOOAH MEMB BER has thhe sole responsibility foor
paymment of the above
a SERV
VICE’s fees and costs. CLIENT fuurther undersstands that in i
the event a Courrt or Administrative Prooceeding maakes or refusses to makee an order foor

Noah Member ___
______________  TBFC _____________
Tw
wins Buiilders Fo
oundatio
on Corp
poration
1010 North Central Avenue,
A Glendale, CA 91202

Tel: 1--888-777-9489 Fax: 1--888-755-14


416

http://ww
ww.builder4u
u.org

SERV VICE’s feess, such an order


o or lackk thereof dooes not relievve NOAH MEMBER
M o
of
indivvidual respon
nsibility for SERVICE’s
S fees.

6. DU UTIES OF THET PARTIE ES


SERV VICE agreees to use thheir best prrofessional efforts to properlyp preepare NOAH H
MEM MBER’s doccuments, rellying upon NOAH ME EMBER to provide SE ERVICE witth
truthfful and accu urate information, includding all neceessary inform mation for inclusion
i intto
the reesearch of Chain
C of Titlee. NOAH MEMBER
M aggrees to coooperate with SERVICE in i
the suuccessful reesearch of NOAH
N MEM MBER’s Chaain of Title in whateveer appropriatte
jurisddiction will adjudicate this matter,, and to proovide such informationn, documents,
paperrs, etc. as maym be reqquired by SE ERVICE to adequatelyy and accuraately preparre
NOA AH MEMBE ER’s researchh of Chain of Title. NOA AH MEMBE ER understaands that succh
coopeeration may y require a substantiall expenditurre of NOA AH MEMBE ER’s time in i
review wing docum ments and otther things relating
r to NOAH
N MEM MBER’s hom me mortgagee,
paymment schedule, and any othero relevannt informatioon. NOAH MEMBER
M f
further retainns
the exxclusive and d final right and power to submit thhose docum ments for theiir research ofo
Chainn of Title that NOAH MEMBER
M beelieves is prooper and corrrect. NOA AH MEMBER R
agreees to indemn nify and hold harmless SERVICE from any and a all liabillity as to thhe
truthffulness and accuracy of o any and all informattion NOAH H MEMBER R provides to t
SERV VICE for the preparatioon of the doccuments. SE ERVICE caannot and dooes not voucch
for thhe truthfulneess or accuraacy of any innformation prrovided to itt by NOAH MEMBER in i
the prreparation of NOAH ME EMBER’S research of Chain
C of Titlee.

7. DIISCHARGE AND WITH HDRAWAL L


Eitheer party may terminate thhis Agreemeent with or without
w state reason or goood cause. In
I
the evvent of term
mination instituted by eitther party, SERVICE
S will only be responsible
r i
in
refunnding any exxcess amounnt from the Sustenance Fee less all costs incurrred up to thhe
time of SERVIC CE’s terminaation, includiing costs off copying the files to bee delivered to
t
NOA AH MEMBE ER, and NOAH MEMB BER will furrther be liabble to SERV VICE for anny
unpaiid fees.

8. ARRBITRATIO ON/WAIVER R OF JURY TRIAL & CHOICEC OFF LAW & FO ORUMS:
Any controversy, claim or diispute in thee course andd scope of thhis contract or o arising ouut
of orr relating to this contracct or the breeach, terminnation, enforrcement, inteerpretation or
o
validity thereof, including the determ mination of the scope or applicabbility of thiis
agreeement to arb bitrate (“disspute”), shalll be determ
mined by coonfidential arbitration
a i
in
Glenddale, Califorrnia, before a sole arbitrrator, in accordance withh the laws of
o the state of
o
Califfornia for this contract.

VICE perforrms all workk in the state of California.


SERV

Noah Member ___
______________  TBFC _____________
Tw
wins Buiilders Fo
oundatio
on Corp
poration
1010 North Central Avenue,
A Glendale, CA 91202

Tel: 1--888-777-9489 Fax: 1--888-755-14


416

http://ww
ww.builder4u
u.org

The arbitration shall


s be adm ministered by
b the JAMS S or Endisppute. This agreement to t
arbitrrate is not intended
i to abrogate eiither party’ss right to reequire a nonn-binding feee
arbitrration pursuaant to Califoornia Business & Professsional Code § 6200-06. Judgment on o
the awward may bee entered intto by any couurt having juurisdiction.

9. EN
NTIRE AGR REEMENT
This agreement comprises
c thhe entire conntract betweeen SERVICE E and NOAH MEMBER R
and supersedes
s any
a prior or o contempooraneous agrreements or representattions, oral or o
writteen, not exp pressly incluuded hereinn. NOAH MEMBER R acknowleddges that no n
repreesentations, promises
p or agreements
a h
have been made
m except those contaiined herein.

10. ACKNOWL
A LEDGMENTT OF RECE EIPT OF AGREEMEN
A NT BY SIGGNING THIIS
RETAAINER AGGREEMENTT, NOAH MEMBER AGREES THAT HE E OR SHE
UNDDERSTANDS AND VO OLUNTARIILY ACCEP PTS THE ABOVE TE ERMS AND D
CONNDITIONS OF
O THIS DONATION
D N ARRANGE EMENT ANND ACKNO OWLEDGEES
RECEEIPT OF A COPY OF
F THIS AGGREEMENT T. NOAH MEMBER
M I OVER 18
IS
YEAARS OF AGE,
A FUL
LLY UNDE ERSTAND THE PR ROVISIONS OF THIIS
AGRREEMENT, AND UNDER THE PA AIN OF PE
ERJURY, MAINTAINS THAT ALL
ACTIION ARISIN
NG FROM THIS
T TRAN
NSACTION ARE CIVILL IN NATUR
RE.

Datedd:_________
____________
N
NOAH MEM
MBER

Datedd: ________
____________
TWIN BUILDERS
B FOUNDAT
TION CORP.

Noah Member ___
______________  TBFC _____________
National Organization of Assistance for
Homeowners of California (NOAH-CA)
500 North State College Blvd. Suite 1100, Orange, CA 92868
Mailing Address: 1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489; Fax: 1-(888) 755-1416
http://www.noahcentral.org

MASTER MEMBERSHIP AGREEMENT: FULL CIRCLE PACKAGE

This Master Membership Agreement (this “Agreement”) is made this ____ day of _______ 2011,
by and between __________________________________________ (“Member”) with subject
property located at ___________________________________________ and NATIONAL
ORGANIZATION OF ASSISTANCE FOR HOMEOWNERS OF CALIFORNIA (NOAH-CA) a dba
of Financial Wellness for Homeowners of Orange County Corporation, a California non-
profit corporation. (hereinafter referred to as “Foundation”, and together with the Member, the
“Parties”).

(This supersedes all previous agreements with the “Foundation” and any other organization
associated with the “Foundation”.)

SECTION 1. SERVICES

The Full Circle Package to be provided by Foundation to Member (also referred to herein as the
“Services”) includes but is not limited to the following:

1) Local NOAH Membership. As a part of the mission of the foundation in organizing


NOAH’s (Local Chapter of the National Organization of Assistance to Homeowners) in
every community where member is situated, Member will have access to the following
Member’s services that will be part of the local NOAH but not limited to:

2) Debt Elimination. Foundation can assist Member through its third party alliance with the
goal of reducing the principal owed on unsecured debt, such as credit card balances,
unsecured debts, and car loans.

3) Credit Restoration and Education. Foundation shall educate Member on the credit
rating system used by credit bureaus, and ways to restore, maintain and maximize
Member’s credit score,

4) Career/Livelihood Realignment and Enhancement. Foundation can assist Member


with Member’s career development needs by posting their resume` in our job board and
maintain them in our database for future referral. Provide training for Member to utilize a
nationwide job search database, providing workshops and tools to identify interests and
skill sets to re-align Member with new employment opportunities, and assisting Member
with applying for funding to pay for training programs. Foundation shall assist
Homeowner in augmenting their income through various resources and/or opportunities
through the Foundation.

5) Financial Planning and Wealth Building. Foundation shall provide education,


consulting and services to assist Member with ways to avoid debt, save money, reach his
or her financial goals and prepare for retirement.

6) Home Protection. Foundation shall assist Member in protecting Member’s home


ownership by providing Member with letters which can be sent to the Lender demanding

FOUNDATION__________ MEMBER(S) Initials __________ Page 1 of 5


National Organization of Assistance for
Homeowners of California (NOAH-CA)
500 North State College Blvd. Suite 1100, Orange, CA 92868
Mailing Address: 1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489; Fax: 1-(888) 755-1416
http://www.noahcentral.org
they comply with applicable law and legal templates which Member can take to their own
local attorney to which will minimize legal fees. Foundation shall also assist Member,
through its strategic alliance with certain law firms and non-profit groups, to have the
Member’s note sold and restructured at no more than the current fair market value. Once
the note has been sold and restructured, an effort will be exerted to allocate from the
closing cost that will be shouldered by lender to fund an interest reserve to service the
interim loan for more or less four months. The unused portion of the interest reserve will
be released to the borrower once the interim loan has been refinanced to a fixed
mortgage note.

7) Mortgage Analysis and Data Research. With the goal of protecting home ownership
and educating Member, Foundation, through its alliance with Twins Builders Foundation
Corporation, assists Member in analyzing Member’s existing home loan(s). The objective
of such analysis is to determine whether the Member’s current home loan documentation
is accurate and in compliance with applicable laws, and if not, whether such errors or
instances of non-compliance may be sufficient to seek revision or rescission of the loan.
Inaccuracies and violations that are found may be used by the Foundation as leverage to
purchase the Member’s mortgage note from Member’s lender(s).

Services can be added, modified or removed at the discretion of the Foundation, in order to best
serve the Member’s interests.

SECTION 2. MEMBERSHIP DONATION COMMITMENT

The donation commitment for the Membership (the “Donation”) will be through Twins Builders
Foundation Corporation (TBFC) who manages all document and process of the Full Circle
Package.

Whatever donation commitment option Member chooses, if the TBFC does not receive their
monthly donation on time by the first day of each calendar month, the Member will have 7
calendar days grace period to ensure the monthly donation is received by the Foundation, after
which the Foundation will not be obligated to continue serving the Member and reserves the right
to close the membership. Any membership Donation paid to the Foundation is non-refundable
unless the Foundation determines otherwise at its sole discretion.

SECTION 3. NO GUARANTEES

Foundation makes no guarantee as to the outcome of any of the services offered except the
diligence of a “Good Father”.

SECTION 4. DISCLAIMER

Foundation is not a credit repair service. Foundation is not a law firm. Foundation is not a credit
counselor. Foundation is not a real estate or mortgage firm. Foundation is not a loan modification
servicer.

The Foundation is a Financial Wellness Firm whose primary mission is to help members keep

FOUNDATION__________ MEMBER(S) Initials __________ Page 2 of 5


National Organization of Assistance for
Homeowners of California (NOAH-CA)
500 North State College Blvd. Suite 1100, Orange, CA 92868
Mailing Address: 1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489; Fax: 1-(888) 755-1416
http://www.noahcentral.org
their homes and become financially well over time.

The Foundation does not, and cannot, guarantee a change or alteration of the Member’s home
loan obligation to the Member’s lender(s).

SECTION 5. INDEMNIFICATION

Foundation will not be liable to Member for any fault or damages, whether direct or indirect, and
disclaims any warranties, expressed or implied. Member shall defend, indemnify, and hold
harmless Foundation, its employees, volunteers, trustees, officers, directors, agents, and all
members from and against any and all liabilities, claims, lawsuits, losses, damages, costs or
expenses, including attorney’s Donations, unless arising as a direct result of Foundation’s willful
misconduct or gross negligence.

In addition, Foundation does not, and shall not, receive any Donation or compensation of any
kind from any attorney to whom the Foundation may refer the Member, and the Member agrees
that Foundation shall not be responsible or liable in any way for any claims, damages or causes
of action suffered or incurred by the Member as the result of the Member following the advice or
recommendations of any attorney referred to, or independently engaged by, the Member.

SECTION 6. REMEDIES

All claims, disputes, and controversies arising out of or relating in any way to this Agreement
will be resolved by binding arbitration administered by a single arbitrator in accordance with
the then existing Commercial Arbitration Rules of the American Arbitration Association
(“AAA”) who is a member of the local State Bar in good standing, actively engaged in the
practice of law and has over 15 years’ experience in real estate law and litigation. If the
Parties cannot agree to an arbitrator, the Parties agree to have AAA select a single arbitrator
from among its arbitration panel.

The arbitrator will deliver the decision or award in writing with a summary of the reasons for
the decision or award, and the decision or award shall be final and binding on all Parties,
their successors and assigns. If deemed appropriate by the arbitrator, the arbitrator may
grant a motion to dismiss the claim or a motion for summary judgment of the claim.
Judgment on the award rendered by the arbitrator may be entered in any court having
jurisdiction thereof.

If the arbitrator determines that a Party has generally prevailed in the arbitration proceeding,
then the arbitrator shall award to that Party its reasonable out-of-pocket expenses related to
the arbitration, including filing Donations, arbitrator compensation, attorney’s Donations and
legal costs.

The arbitration proceedings and arbitration award shall be maintained by the Parties as
strictly confidential, except as is otherwise required by court order or as is necessary to
confirm, vacate or enforce the award and for disclosure in confidence to the Parties’
respective attorneys, tax advisors and senior management and to family members of a Party
who is an individual.

FOUNDATION__________ MEMBER(S) Initials __________ Page 3 of 5


National Organization of Assistance for
Homeowners of California (NOAH-CA)
500 North State College Blvd. Suite 1100, Orange, CA 92868
Mailing Address: 1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489; Fax: 1-(888) 755-1416
http://www.noahcentral.org

This Agreement is an election to resolve claims, disputes, and controversies by arbitration


rather than the judicial process. IT IS UNDERSTOOD THAT THE PARTIES WAIVE ANY
RIGHT TO A JURY TRIAL OR A TRIAL IN COURT. The Parties understand that the rules
applicable to arbitration and the rights of the Parties in an arbitration differ from the rules and
rights applicable in court. The arbitration will be conducted at an appropriate time and place
set by the arbitrator in the county where the member resides.

I / We have read the above arbitration provisions and agree to the terms and conditions.

Dated: , 2010 Member/s

SECTION 7. MISCELLANEOUS PROVISIONS

1) Independent Legal Counsel. The Parties have been advised to retain and consult with
independent legal counsel regarding this Agreement and any and all subsequent
Agreements entered into between Member and Foundation.

2) Entire Agreement. This Agreement represents the entire agreement between the Parties.
This Agreement supersedes all prior Agreements between Foundation and Member. For
the protection of the Member and the Foundation, the Member shall not rely on any oral
statement of any employee or representative of the Foundation that is, or may be,
inconsistent with the terms of this Agreement.

3) Execution in Counterparts. This Agreement may be executed in counterparts, and


duplicate originals of each of the counterparts or duplicate originals taken together will
constitute one valid and binding Agreement between the Parties.

4) Facsimile Copies Valid. Copies sent by facsimile transmission will be valid for all required
notices, consents and executions of this Agreement, provided that the original written
notice, consent or execution is also sent at the same time by first class mail.

5) Favorable Interpretation of Agreement. No part of this Agreement will be interpreted for or


against any party because that party or that party’s legal counsel drafted it.

6) Modifications by Written Agreement. This Agreement may be later amended or modified


only by written agreement signed by all Parties.

7) Termination. Either party may terminate this Agreement at any time, with or without notice,
if the other party is in breach of this Agreement or of any other written agreement into which
the parties have entered. Any membership Donation paid to the Foundation is non-
refundable unless the Foundation determines otherwise at its sole discretion.

8) Governing Law. This Agreement shall be governed by and construed in accordance with
the laws of the state of member, without giving effect to conflict of laws.

FOUNDATION__________ MEMBER(S) Initials __________ Page 4 of 5


National Organization of Assistance for
Homeowners of California (NOAH-CA)
500 North State College Blvd. Suite 1100, Orange, CA 92868
Mailing Address: 1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489; Fax: 1-(888) 755-1416
http://www.noahcentral.org

9) Severability. If any provision of this Agreement is held by a court of competent jurisdiction


to be illegal, invalid or unenforceable, such provision may be modified by such court in
compliance with the law and, as modified, enforced. All other terms and conditions of this
Agreement shall remain in full force and effect and shall be construed in accordance with
the modified provisions as if such illegal, invalid or unenforceable provision had not been
contained in this Agreement.

10) Notice. All notices and other communications in connection with this Agreement shall be in
writing. Notice shall be considered effective when delivered to the “Foundation’s” office
address, fax number, or e-mail.

11) ACKNOWLEDGMENT OF RECEIPT OF AGREEMENT BY SIGNING THIS


RETAINER AGREEMENT, NOAH MEMBER AGREES THAT HE OR SHE
UNDERSTANDS AND VOLUNTARILY ACCEPTS THE ABOVE TERMS AND
CONDITIONS OF THIS DONATION ARRANGEMENT AND ACKNOWLEDGES
RECEIPT OF A COPY OF THIS AGREEMENT. NOAH MEMBER IS OVER 18
YEARS OF AGE, FULLY UNDERSTAND THE PROVISIONS OF THIS
AGREEMENT, AND UNDER THE PAIN OF PERJURY, MAINTAINS THAT ALL
ACTION ARISING FROM THIS TRANSACTION ARE CIVIL IN NATURE.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first
written above.

NOAH-CALIFORNIA

By: __________________________

Member/Borrower Signature: ________________________________ Date: _______________

Member/Borrower Name (Print): ___________________________________

Member/Co-Borrower Signature: _____________________________ Date: _______________

Member/Co-Borrower Name (Print): ___________________________________

Address for Notice:

Facsimile:

Email Address:

Phone number(s): _________________________________

FOUNDATION__________ MEMBER(S) Initials __________ Page 5 of 5


AUTHORIZATION FOR RELEASE OF FINANCIAL RECORDS AND INFORMATION 
Twins Builders Foundation Corporation
Legal Servicer for the
Law Offices Of Dickson and Associates
Roy Chester Dickson, Esq
Representing National Organization of Assistance for Homeowners of California
1010 North Central Avenue, Glendale, CA 91202
Tel. No. (888) 777-9489 Fax: (888) 755-1416
Email: legal@builder4u.org

Re:  ___________________________ Name 
       ___________________________ Property Address 
       ___________________________ Loan Number 

TO WHOM IT MAY CONCERN: 

  This Authorization, or a copy thereof, will permit and authorize _________________________ 
to release or otherwise provide to the Law Offices of Dickson and Associates (hereinafter “Law Offices”) all financial 
information or documents contained in my loan file or account, including public and non‐public information, loan 
balance information, loan status, payment history and payment activity, any property information and final pay‐off 
statement. 

These financial records and information are to be used by Law Offices toward pursuing and working toward a loan 
modification or loan alternative(s) on my behalf. 

The Lender/Mortgage Servicer or Provider to whom this Authorization is presented may take reasonable steps to verify 
the identity of Law Offices listed above but will have no liability to verify said identity when Law Offices inquires as to my 
account or seeks information thereon, nor will the Lender/Mortgage Servicer or Provider have any liability whatsoever 
for what is done by Law Offices with the information provided with regard to my account. 

I further agree to defend, indemnify and hold harmless the Lender/Mortgage Servicer or Provider from any and all 
claims, suits, actions or demands against the Lender/Mortgage Servicer or Provider which I or my heirs or assigns may 
have as a result of the providing of information by the Lender/ Mortgage Servicer or Provider to Law Offices or any 
person identifying themselves as a representative of Law Offices. 

Date: ______________________                 Signature: ______________________________________ 

Last Four # of SSN: ___________      Name (Print): ___________________________________ 

Date: ______________________                 Signature: ______________________________________ 

Last Four # of SSN: ___________      Name (Print): ___________________________________ 

Your signature above indicates your agreement to the terms of this Authorization. 

Note:  No information contained in your account file can or will be provided to Law Offices until you have provided this 
signed document to Law Offices. 

Legal Servicer for the Law Office of Dickson and Associates Representatives: 

       Juan Solis          Fernando Trivisonno 


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 
CLIENT INITIAL INTAKE QUESTIONNAIRE

Your Name:

Spouse:

Contact Phone: Fax:

Email address:

Address of Property:

(State) (Zip Code)

Your Occupation:

Wife’s Occupation:

Is this your Primary Residence?

Do you own other properties?

Are they presently rented out?

TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 
How long have you owned your present home?

Names of any other persons living with you (please list your relationship to these people as well:
“child”, “family”, “roommate”, etc):

1.

2.

3.

4.

5.

1. Are you currently in default on your 1st mortgage? YES NO

a. “If YES, is there a Sale Date set for your property? YES NO

b. “Date:

2. Have you been served any legal papers? YES NO

3. When did you purchase you home? month year

TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 

4. Was this a: Purchase Refinance

5. If your loan was a refinance loan, were any of the funds used for upgrades on the home?

YES

NO

6. Did you receive early disclosures within three days after you applied for the loan?

YES

NO

7. Was the mortgage broker/mortgage company recommended to you (e.g. by your realtor)?

YES

NO

8. Did the Mortgage Broker explain and/or recommend certain loan options to you?

YES

NO

9. Did the Mortgage Broker disclose that the interest rate on the loan was not fixed?

YES NO

10. Did the Mortgage Broker tell you how long the interest rate would stay fixed?

YES NO
TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 

11. Did the Mortgage Broker explain the possibility of the interest rate increasing and how
payments were calculated? YES NO

12. Did the Mortgage Broker ever ask you to state an income different from what you earned?

YES NO

“If so, about how much was your actual income (per mo)? $

“And the amount stated on the loan application? $

13. Please state any other important misrepresentations or issues you felt the representative

failed to disclose:

14. At your closing, were you given a chance to read over the documents?

YES NO

15. Did you feel rushed during the closing process? YES NO

TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 

YOUR EFFORTS TO NEGOTIAGE and/or MODIFY THE LOAN

16. Who currently services your loan? (Is it the company you make the payments to)

17. Have you already requested a Loan Modification? YES NO

18. Has the review of your request been completed? YES NO

19. Were you: Approved Denied

20. Were you given a reason for Denial? YES NO

Please list reason(s) if given:

What is your monthly income? Take home Gross

(Please list each source of income separately and list all possible sources. This information
will not be turned over to your servicer.)

TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 

What are your current payments on:

Property Taxes:

Homeowners Insurance:

HOA Dues:

Your cooperation in this endeavor is required. Please forward to TBFC any correspondence from
any source regarding the status of your loan. We will need all the legal documents, collection
letters, threats, and intimidation letters in order to build your case.

It is recommended that you keep a record of ALL harassing phone calls. It is against the law for
collectors to call you at work, if they know you cannot accept collection calls. In order to assist
you, TBFC cannot perform to (100%) efficiency without your assistance.

Please take advantage of all of the services in our financial, credit restoration and debt
solution programs.

TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 
FOR INTERNAL USE ONLY

Was MERS named as a nominee mortgage (lender) YES NO

Was a Qualified Written Request sent out? YES NO

Date QWR Request sent:

Was a Debt Validation letter sent out? YES NO

Date Sent:

If mortgage was a refinance within the last (3) years, has a rescission letter been sent out?

YES NO

Name of Personal Assistant:

Email address of Personal Assistant:

TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


Twins Builders Foundation Corporation
1010 North Central Avenue, Glendale, CA 91202
Tel: 1-888-777-9489 Fax: 1-888-755-1416
http://www.builder4u.org 
This application was entered into the TBFC CRM system by:

(Your name)

(Your email address)

(Date of entry)

Supervisor:

TBFC is dedicated to assist you in your Financial Wellness program. All materials provided by consumer are
governed by the Red Flag Compliance Act, HIPPA, FDCPA, FCRA and FACTA. None of the information provide
by the consumer will be sold or disseminated to the public in any form. Legal Disclaimer: The legal information on
this form should not be construed as formal legal advice nor the formation of an attorney client relationship.

Form TBFC16 (Rev. 2-2010a)


AUTHORIZATION TO NEGOTIATE PURCHASE OF NOTE
(Must be notarized)

Name of Homeowner: ________________________


Property Address: ________________________
________________________
Name of Lender and Loan No.: ________________________

Dear Note Holder:

Please let this Authorization, or a copy thereof, serve to permit and authorize Twins
Builders Foundation Corp. (hereinafter “TBFC”), its staff, attorneys, affiliates and assignees
to negotiate with your company a purchase agreement of the promissory note secured
by the above-stated property.

By my signature below I understand that if an agreement is reached for the purchase of


my promissory note secured by the property located at the address above, that TBFC or
its assignees will become the holder of my promissory note and that I will thereafter be
indebted to TBFC or its assignees.

I understand that the purchase of my note by TBFC or its assignees does not require or
involve transferring Title to the property listed above.

The bank, investor, institution or company to whom this Authorization Is provided may
take reasonable steps to verify the identity of the negotiating party, but will have no
liability to verify said identity.

By my signature below, I agree to defend, indemnify, and hold harmless the bank,
investor, institution or company from any and all claims, suits, actions or demands against
the bank, investor, institution or company which I or my heirs and assigns may have as a
result of the bank, investor, institution or company negotiating and selling the promissory
note secured by my property identified above to TBFC or its assignees.

This Authorization shall be valid for a period of five (5) years unless revoked by me with
the acceptance of TBFCin a writing which bears both signatures.

SIGNED AND AGREED TO:

Dated:

(Client’s printed name) (Client’s printed name)

Client’s signature Client’s signature

CC: Original to TBFC


Client
Investor
Legal Department
01234 520ÿ
ÿÿ‹Œ‹ŒÿŽ‘
7
ÿ
’“
89020
1ÿ
”
•–ÿ
—˜ “”™“š
ÿ›–“
7
”œ
1 0
2
•–“šÿ
’—ÿ
ÿ1ÿ2ÿ5ÿÿ‹žŒž
10ÿ
ÿ!2ÿ"#ÿ
1010 North Central Avenue, Glendale, CA 91202

ÿ Tel. No. 1-888-777-9489 Fax No. 1-888-755-1416

ÿ
ÿ
$%&ÿ()*+,-.)ÿ/0112344ÿ67ÿ8629:;:3ÿ<9;93=379ÿ6>ÿ?@22379ÿ<32ABC32Dÿ
ÿÿÿÿÿÿÿE++)*FFÿ
GHIÿKLMNOPQRHÿGKSTUÿUVVWHPPÿXYWÿZÿ[OZNQXQHVÿ\WQ]]H^ÿGH_OHP]ÿ
O^VHWÿ̀abÿGHcONZ]QY^ÿdeÿSHM]QY^ÿfghhijklHmlkmÿ
ÿ
n*o)ÿp,)qro+os&ÿ
2ÿtuÿÿvÿ3
ÿ9wuÿxÿ5yuÿz{#|}|#}ÿÿ
~tÿuyÿÿy€€ÿÿÿuyÿuÿÿuÿ‚tÿ€€ÿtÿ
4yÿƒÿ‚uwÿ‚‚€ÿÿyÿƒtÿÿÿ‚ÿ€ÿ„yÿ
uyÿ€€ÿuÿÿy‚ÿ€ÿ€wÿuÿ…€ÿvÿ…{~ÿ
ÿÿvÿÿÿÿ…ÿuÿtuÿ„yÿ985†2ÿ€€ÿuÿ
ÿy‚ÿ€ÿ‚uywÿuÿÿ‡€ÿÿ9…{ÿ†ÿuÿÿ
tÿÿuÿtuÿ‚ÿuÿ‚u€ÿƒÿ€ÿƒtÿ€uÿˆÿÿ012345ÿ7€uÿ
7u€uÿÿÿ‹ÿ
Œ‹ŒÿŽ
ÿ1
‘ÿ’“
ÿ2
”•–ÿ—˜
ÿ5“”™“ÿšÿ›–
“ÿ
”œ•–“šÿ’—ÿ
ÿ!2ÿ
‹ž"Œ#žÿvÿtuÿ
„yÿ€€ÿvÿÿyu€€ÿuÿyuÿÿvÿuÿÿ…ƒÿ
€ÿ3
ÿ9wuÿxÿ5yuÿz{#|}|#}ÿy€wÿÿuÿƒ€ÿuÿ
tÿ€ÿuÿyƒÿ€ÿuÿw€ÿ~yÿuy{~ÿ
ÿ
5ytÿ
ÿ
uuv‰ÿ0ƒÿ
ÿ
01234015ÿ478103912340ÿ4
ÿ1 3 210 ÿ
47ÿ4 4ÿ0 7 ÿ
ÿ
ÿÿ!
"#‡$ˆ$‡ÿˆ%
ÿŠ‹&'Œÿ4( )*%‘ÿ1*
Žÿ Œ’“ÿ%”•
+ÿ '%‘ÿ–,$—$ÿ ÿ
-.˜“‘™’“—ÿ”ÿš‡›$ˆ,›ÿ
/0 1 234 ÿ
1ÿ 5 6 ,
7''89::;;;+ 2<17=&12>%/212?<+</@ÿ
ÿ 2% (% 8 7< 2 %9ÿABBBCÿ""No. "=BD5Bÿ ÿ
ÿ
ÿ
1E&)F)(%9ÿABBBFax
Tel. No. 1-888-777-9489
CÿG,,=6D61-888-755-1416
#ÿ ÿ
IJKLÿ
ÿ
NOPQORSTÿUVWOÿ
JQQROTTXÿ
JQQROTTYÿ
Z[\]^ÿ_\V\Oÿ`[aÿ
ÿ
NbVPÿUbcÿÿÿ
ÿ
IOVRÿ_[RÿbRÿdVQVWcÿÿ
ÿ
efOVTOÿ\ROV\ÿ\g[TÿfO\\ORÿVTÿVÿhijVf[k[OQÿlR[\\OPÿROijOT\mÿjPQORÿ\gOÿnOQORVfÿ_ORo[pORÿJp\^ÿlg[pgÿ
[TÿVÿaVR\ÿbkÿ\gOÿqOVfÿLT\V\Oÿ_O\\fOWOP\ÿeRbpOQjROTÿJp\^ÿXYÿrs_sZsÿYtuvwOxsÿÿÿ
ÿ
Xsÿ JÿpbWafO\OÿVPQÿ[\OW[yOQÿT\V\OWOP\ÿbkÿ\gOÿfbVPÿg[T\bR]ÿkRbWÿ\gOÿQV\Oÿbkÿ\gOÿfbVPÿ\bÿ
\gOÿQV\Oÿbkÿ]bjRÿROTabPTOÿ\bÿ\g[TÿfO\\ORÿ[PpfjQ[Pz^ÿ{j\ÿPb\ÿf[W[\OQÿ\b^ÿVffÿROpO[a\Tÿ{]ÿlV]ÿbkÿ
aV]WOP\ÿbRÿb\gORl[TOÿVPQÿVffÿpgVRzOTÿ\bÿ\gOÿfbVPÿ[PÿlgV\OoORÿkbRWsÿKg[Tÿf[kOÿbkÿ\gOÿfbVPÿ
\RVPTVp\[bPVfÿg[T\bR]ÿTgbjfQÿ[PpfjQOÿ\gOÿQV\OÿbkÿOVpgÿVPQÿOoOR]ÿQO{[\ÿVPQÿpROQ[\ÿ\bÿVP]ÿ
VppbjP\ÿROfV\OQÿ\bÿ\g[TÿfbVP^ÿlgO\gORÿROT\R[p\OQÿbRÿPb\ÿROT\R[p\OQ^ÿ\gOÿPV\jROÿVPQÿajRabTOÿbkÿ
OVpgÿTjpgÿQO{[\ÿVPQÿpROQ[\^ÿVPQÿ\gOÿPVWOÿVPQÿVQQROTTÿbkÿ\gOÿaV]OOÿbkÿVP]ÿ\]aOÿbkÿ
Q[T{jRTOWOP\ÿROfV\OQÿ\bÿ\g[TÿfbVPsÿ
ÿ
Ysÿ JÿpbWafO\OÿVPQÿ[\OW[yOQÿT\V\OWOP\ÿbkÿVffÿVQoVPpOTÿbRÿpgVRzOTÿVzV[PT\ÿ\g[TÿfbVP^ÿ
ROT\R[p\OQÿbRÿjPROT\R[p\OQ^ÿROpboORV{fOÿbRÿPbP|ROpboORV{fO^ÿVPQÿkbRÿVP]ÿajRabTOÿ\gV\ÿVROÿPb\ÿ
ROkfOp\OQÿbPÿ\gOÿf[kOÿbkÿfbVPÿg[T\bR]ÿ\RVPTVp\[bPÿT\V\OWOP\ÿaRbo[QOQÿ[PÿVPTlORÿ\bÿijOT\[bPÿ
}Xsÿÿÿ
ÿ
~sÿ JÿpbWafO\OÿVPQÿ[\OW[yOQÿT\V\OWOP\ÿbkÿ\gOÿOTpRblÿVppbjP\ÿbkÿ\gOÿfbVP^ÿ[kÿVP]^ÿkRbWÿ
\gOÿQV\Oÿbkÿ\gOÿfbVPÿ\bÿ\gOÿQV\Oÿbkÿ]bjRÿROTabPTOÿ\bÿ\g[TÿfO\\OR^ÿ[PpfjQ[Pz^ÿ{j\ÿPb\ÿf[W[\OQÿ\b^ÿ
VP]ÿROpO[a\TÿbRÿQ[T{jRTOWOP\Tÿl[\gÿROTaOp\ÿ\bÿROVfÿOT\V\OÿaRbaOR\]ÿ\VOT^ÿk[ROÿbRÿgVyVRQÿ
[PTjRVPpO^ÿkfbbQÿ[PTjRVPpO^ÿWbR\zVzOÿ[PTjRVPpO^ÿpROQ[\ÿ[PTjRVPpO^ÿajRpgVTOÿWbR\zVzOÿ
[PTjRVPpO^ÿbRÿVP]ÿb\gORÿ\]aOÿbkÿ[PTjRVPpOÿaRbQjp\sÿ
ÿ
€sÿ VoOÿ]bjÿajRpgVTOQÿVPQÿpgVRzOQÿ\bÿ\gOÿVppbjP\ÿVP]ÿnbRpO|efVpOQÿ‚PTjRVPpOƒÿ
ÿ
vsÿ JÿpbWafO\OÿVPQÿ[\OW[yOQÿT\V\OWOP\ÿkRbWÿ\gOÿQV\Oÿbkÿ\gOÿfbVPÿ\bÿ\gOÿQV\Oÿbkÿ]bjRÿ
ROTabPTOÿ\bÿ\g[TÿfO\\ORÿbkÿ\gOÿVWbjP\TÿpgVRzOQÿkbRÿVP]ÿkbRpOQ|afVpOQÿ[PTjRVPpO^ÿ\gOÿQV\Oÿbkÿ
\gOÿpgVRzO^ÿ\gOÿPVWOÿbkÿ\gOÿ[PTjRVPpOÿpbWaVP]^ÿ\gOÿROfV\[bPÿbkÿ\gOÿ[PTjRVPpOÿpbWaVP]ÿ\bÿ
]bjÿbRÿVÿROfV\OQÿpbWaVP]^ÿ\gOÿVWbjP\ÿbkÿpbWW[TT[bPÿ]bjÿROpO[oOQÿkbRÿOVpgÿkbRpO|afVpOQÿ
[PTjRVPpOÿOoOP\^ÿVPQÿVPÿ[\OW[yOQÿT\V\OWOP\ÿbkÿVP]ÿb\gORÿOaOPTOTÿROfV\OQÿ\gORO\bsÿ
ÿ
tsÿ JÿpbWafO\OÿVPQÿ[\OW[yOQÿT\V\OWOP\ÿkRbWÿ\gOÿQV\Oÿbkÿ\gOÿfbVPÿ\bÿ\gOÿQV\Oÿbkÿ]bjRÿ
ROaf]ÿ\bÿ\g[TÿfO\\ORÿbkÿVP]ÿTjTaOPTOÿVppbjP\ÿOP\R[OTÿVPQ„bRÿVP]ÿpbRabRV\OÿVQoVPpOÿOP\R[OTÿ
ROfV\OQÿ[PÿVP]ÿlV]ÿ\bÿ\g[TÿfbVPsÿ
ÿ
…sÿ ÿJÿpbWafO\OÿVPQÿ[\OW[yOQÿT\V\OWOP\ÿkRbWÿ\gOÿQV\Oÿbkÿ\gOÿfbVPÿ\bÿ\gOÿQV\Oÿbkÿ]bjRÿ
ROaf]ÿ\bÿ\g[TÿfO\\ORÿbkÿVP]ÿaRbaOR\]ÿ[PTaOp\[bPÿkOOT^ÿaRbaOR\]ÿaROTORoV\[bPÿkOOT^ÿÿ{Rb†ORÿ
ÿ ÿ
ÿ ÿ
ÿ
ÿ ÿ
1234314ÿ67789ÿ
22
38
ÿ67789ÿ
4 2ÿ1431 34ÿ67789ÿ1 ÿ17 ÿ833
ÿ6778ÿ1 ÿ7274878ÿ
7
7ÿ34ÿ
4ÿ
ÿ1ÿ38ÿ 1
4ÿÿÿ
ÿ
ÿ 7436ÿ7ÿ2 138314ÿ47 ÿ7ÿ77ÿ16ÿ 8ÿ
41 ÿ417ÿ
ÿ
1 378ÿ
34ÿ
7
ÿ
4ÿ77 ÿ8ÿ677ÿ

348ÿ7ÿ 1
4ÿ16ÿ7ÿ!1 17 8ÿ
ÿ
"ÿ # 7
87ÿ

ÿ12378ÿ16ÿ
ÿ2 127 ÿ34827314ÿ 721 8ÿ
4ÿ
22
38
89ÿ 17 ÿ2 37ÿ
12343148ÿ16ÿ
79ÿ 3 8ÿ
4ÿ3413789ÿ
4ÿ78ÿ1 ÿ3 7ÿ
4867 8ÿ34ÿ2
74ÿ7 716ÿ
ÿ
$%ÿ &ÿ12 77ÿ12ÿ16ÿ
4ÿ'7ÿ(1
4ÿ
48
314ÿ 721 ÿ1 ÿ 721 8ÿ
4ÿ
4ÿ 721 8ÿ
343
34ÿ
4ÿ
78ÿ61 ÿ
4ÿ)
ÿ14ÿ2 18)ÿ81 ÿ1ÿ7ÿ!1 17 8ÿ34ÿ1447314ÿ3ÿ
38ÿ 1
4ÿ6 1ÿ7ÿ
7ÿ16ÿ7ÿ 1
4ÿ1ÿ7ÿ
7ÿ16ÿ1 ÿ 72 ÿ1ÿ38ÿ 77 ÿ
ÿ
$$ÿ &ÿ12 77ÿ
4ÿ3737ÿ8
774ÿ16ÿ
4ÿ
4ÿ
ÿ218*273314ÿ
7
8ÿ34 34ÿ
7
ÿ14ÿ34ÿ3ÿ7ÿ76
 ÿ1 79ÿ
4ÿ7ÿ
14ÿ16ÿ7
ÿ14 ÿ76
 ÿ
ÿ
$+ÿ &ÿ12 77ÿ
4ÿ3737ÿ8
774ÿ16ÿ
4ÿ
7ÿ
78ÿ
7ÿ1ÿ38ÿ 1
4ÿ6 1ÿ7ÿ

7ÿ16ÿ38ÿ 1
4ÿ1ÿ7ÿ
7ÿ16ÿ1 ÿ 72 ÿ1ÿ38ÿ 77 ÿ
ÿ
$,ÿ &ÿ12 77ÿ
4ÿ3737ÿ8
774ÿ6 1ÿ7ÿ
7ÿ16ÿ7ÿ 1
4ÿ1ÿ7ÿ
7ÿ16ÿ1 ÿ
72 ÿ1ÿ38ÿ 77 ÿ16ÿ
4ÿ6778ÿ34 7ÿ1ÿ1369ÿ7749ÿ1 ÿ
74ÿ7ÿ 1
4ÿ1 ÿ1ÿ767 ÿ
4ÿ
2
74ÿ1 ÿ2
748ÿ7ÿ47 ÿ7ÿ7 8ÿ16ÿ7ÿ 1
4ÿ
ÿ
$-ÿ &4ÿ3737ÿ8
774ÿ16ÿ7ÿ 74ÿ
14ÿ4777ÿ1ÿ2
*166ÿ7ÿ 1
4ÿ34ÿ6 ÿ
ÿ
$.ÿ &ÿ6 ÿ
4ÿ12 77ÿ12 77483 7ÿ76343314
ÿ3314
ÿ16ÿ
ÿ
48
314ÿ178ÿ

4ÿ17 ÿ833
ÿ7 8ÿ87ÿ34ÿ
4ÿ16ÿ7ÿ1748ÿ1 ÿ 71 8ÿ 7/787ÿ1 ÿ 767 7ÿ1ÿ
7 734ÿÿÿ
ÿ
$0ÿ &ÿ12 77ÿ
4ÿ3737ÿ8
774ÿ6 1ÿ7ÿ
7ÿ16ÿ38ÿ 1
4ÿ1ÿ7ÿ
7ÿ16ÿ1 ÿ
72 ÿ1ÿ38ÿ 77 ÿ16ÿ7ÿ
149ÿ2
74ÿ
79ÿ2 2187ÿ
4ÿ 732374ÿ16ÿ
ÿ61 7 18 7ÿ
72748789ÿ123ÿ7ÿ
789ÿ 7
ÿ67789ÿ
1 47ÿ67789ÿ2 16788314
ÿ6778ÿ
4ÿ17 ÿ
7274878ÿ
4ÿ188ÿ
ÿ
7ÿ 774ÿ
7ÿ

348ÿ1 ÿ
887887ÿ1ÿ38ÿ 1
4ÿ
4ÿ77 ÿ1 ÿ
41ÿ8ÿ
7ÿ1 ÿ677ÿ38ÿ 717
7ÿ1 ÿ414* 717
7ÿ
ÿ
$ÿ &ÿ12 77ÿ
4ÿ3737ÿ8
774ÿ16ÿ7ÿ
149ÿ2
74ÿ
79ÿ2 2187ÿ
4ÿ
732374ÿ16ÿ
ÿ6778ÿ61 ÿ7ÿ2 72

314ÿ
4ÿ63 34ÿ16ÿ7ÿ1 334
ÿ2 116ÿ16ÿ
39ÿ
4ÿ
747ÿ
2 1168ÿ16ÿ
3ÿ1 ÿ
4ÿ822 774
ÿ2 1168ÿ16ÿ
3ÿ34ÿ38ÿ
87ÿ
ÿ
$"ÿ 7ÿ6 ÿ4
79ÿ
 788ÿ
4ÿ7 72147ÿ4 7 ÿ16ÿ7ÿ 74ÿ1 7 ÿ16ÿ7ÿ1 334
ÿ
1 
7ÿ417ÿ34 34ÿ7ÿ4
79ÿ
 788ÿ
4ÿ2147ÿ4 7 ÿ16ÿ
4ÿ 877ÿ47 ÿ7ÿ
 8ÿ1 ÿ17 ÿ633
ÿÿ38ÿ 7/78ÿ38ÿ 734ÿ
7ÿ2 8
4ÿ1ÿ27314ÿ$0-$4654+5ÿ16ÿ7ÿ
 ÿ4ÿ(7434ÿ&9ÿ3ÿ 7/3 78ÿ7ÿ87 37 ÿ1ÿ37436ÿ7ÿ1 7 ÿ16ÿ7ÿ7 ÿ
ÿ
+%ÿ 7ÿ4
79ÿ
 788ÿ
4ÿ7 72147ÿ4 7 ÿ16ÿ
4ÿ
87 ÿ87 37 89ÿ87 37 89ÿ8 *
87 37 89ÿ143474ÿ87 37 89ÿ
*2ÿ87 37 8ÿ1 ÿ8273
ÿ87 37 8ÿ61 ÿ38ÿ1 
7ÿ
1
4ÿ
ÿ
+$ÿ &ÿ12ÿ16ÿ
4ÿ1 
7ÿ#11 34ÿ
4ÿ27 334ÿ& 7774ÿ
4ÿ
ÿ38 18 7ÿ
2
7748ÿ2 137ÿ1ÿ
4ÿ4781 8ÿ3ÿ 7827ÿ1ÿ
4ÿ1 
7*
7ÿ87 3ÿ 8ÿ1 ÿ
17 ÿ8273
ÿ2 2187ÿ73 7ÿ 7
7ÿ1ÿ7ÿ8
3ÿ& 7774ÿ
4ÿ
4ÿ
4ÿ
ÿ&74748ÿ

4ÿ222 7748ÿ7 71ÿ


ÿ
++ÿ 6ÿ
ÿ12ÿ16ÿ7ÿ#11 34ÿ
4ÿ27 334ÿ& 7774ÿ
8ÿ 774ÿ63 7ÿ3ÿ7ÿ2679ÿ
2 137ÿ
ÿ12ÿ16ÿ267ÿ31 ÿÿ
4ÿ7ÿ# 18278ÿ222 7749ÿ267ÿ31 ÿ-+- .ÿ
ÿ
ÿ ÿ
123ÿ 567ÿ89
7 ÿ9 7ÿ98 ÿ77687ÿ8
7 ÿÿ98ÿ5 77ÿ8 7 ÿ98ÿ8ÿ ÿ
7 8ÿ9 77
78ÿ 797 ÿÿ6ÿ983ÿ
ÿ
13ÿ ÿÿÿ67ÿ 7ÿ7 7 ÿÿ87 ÿ8ÿ67ÿ 3ÿ
ÿ
13ÿ 7ÿÿ9ÿ7 8 ÿ
97 ÿ7 8 ÿ 7 8 ÿ8878ÿ7 8 ÿ79ÿ
7 8 ÿ ÿ9!ÿ7 8ÿ9 77
78ÿ"6ÿ 77ÿÿ6ÿ983ÿ
ÿ
1#3ÿ ÿ" 78ÿ
98ÿ 7ÿ98 ÿ" !ÿ 7  7ÿ98 ÿ98ÿ
 98ÿ
8ÿ ÿ  9
ÿ 797 ÿÿ98ÿ 79ÿ 79 8ÿ6ÿ98ÿ98 ÿ
9 ÿ983ÿ
ÿ
1$3ÿ ÿ

9 ÿÿ9ÿ%7 ÿ ÿ98 9 ÿ79ÿ77ÿ9 7 ÿ ÿ98ÿ


ÿÿ79ÿ7 7ÿ
78 7 7 ÿ8ÿ8878ÿ"6ÿ6ÿ983ÿ
ÿ
1&3ÿ 'ÿ6ÿ9ÿ()*+ÿ,7897 ÿ( 97ÿ-98.ÿÿ'ÿ67ÿ98"7 ÿÿ7 ÿ678ÿ 78ÿ67ÿ
77 8ÿ()*+ÿ8
7 ÿ987 ÿÿ6ÿ983ÿÿ797ÿ996ÿ9ÿÿÿ67ÿ()*+ÿ(787ÿ
*7 3ÿ
ÿ
1/3ÿ 797ÿ97ÿ67ÿÿ89
7ÿ98 ÿ9 7ÿÿ98ÿ9 87ÿÿ697ÿ 7987 ÿÿ  7ÿ
98ÿ79ÿ7 7ÿ8ÿ6ÿ97ÿ"68ÿ%ÿ0#1ÿ
86ÿÿ67ÿ78ÿ 97ÿ ÿ9ÿ98ÿ
7ÿ
783ÿ
ÿ
223ÿ ÿÿÿ ÿ37ÿ-98ÿ5 9898ÿ6  ÿ98! ÿ" !ÿ
ÿ ÿ4-+ÿ
 79 677ÿÿ9ÿ98ÿ997 ÿ"6ÿ6ÿ
 97ÿ983ÿ
ÿ
253ÿ 7ÿÿ9ÿ78ÿ87 ÿ78ÿ 7  ÿ

898ÿ7ÿ ÿ98ÿ67 ÿ

ÿÿ 7 7 ÿ 99ÿ"6ÿ 77ÿÿ98ÿ

898ÿ7"778ÿÿ98 ÿ67ÿ6 "7 3ÿ


ÿ
213ÿ 8ÿ7
77 ÿ97
78ÿÿ67ÿÿ9
8ÿ877 7 ÿÿ 7897ÿ67ÿ
 97ÿ9ÿÿ67ÿ
97ÿÿ ÿ 7873ÿ
ÿ
223ÿ 7ÿÿ9ÿ" 78ÿ ÿ 7 7 ÿ

898ÿ7"778ÿÿ98 ÿ98ÿ88 9"7 ÿ


6 ÿ9 7ÿ 79 8ÿ6ÿ
 973ÿ
ÿ
23ÿ ÿ22/ÿ 778ÿ6ÿÿ67ÿ6 ÿ9ÿÿ67ÿ98ÿ0 89 ÿ87 7 ÿ7 " ÿ
97ÿ69 7 ÿ79ÿ77 ÿ 7 ÿ878ÿ77 ÿ !7 ÿ 7ÿ88ÿ77 ÿ9 ÿ
7%787ÿ77 ÿ
7987ÿ77 ÿ  97ÿ9 987ÿ77 ÿ731ÿ997 ÿ"6ÿ6ÿ983ÿ
ÿ
ÿ 8ÿ6 ÿ7ÿ9 7 ÿ69ÿÿ
ÿ9!8"7 7ÿ 77ÿÿ6ÿ997 ÿ" 78ÿ
797ÿ"68ÿ12ÿ87ÿ 9 ÿ 98ÿÿ51ÿ:3+33ÿ+78ÿ1#207105101ÿ98 ÿ*73ÿ4ÿ
+78ÿ2223150710513ÿ
ÿ
ÿ 8ÿ6 ÿ9ÿ7ÿ9 7 ÿ69ÿ67ÿ6 "7 01ÿ67 78ÿ"ÿ77!ÿ67ÿ 77 ÿÿ
9
97 ÿ ÿ98 ÿ 79897ÿ79ÿ77ÿ ÿ796ÿ9 7ÿÿ
ÿ"6ÿ67ÿ978ÿ98 ÿ
797ÿ67 783ÿÿ567ÿ6 "7 01ÿ9ÿ 77 7ÿ67ÿ 6ÿÿ77!ÿ9 ÿ 9
97ÿ ÿ796ÿ
98ÿÿ98ÿ9 ÿÿ+78ÿ1#2ÿÿ57ÿ51ÿÿ67ÿ:87 ÿ+97ÿ 73ÿ
ÿ
ÿ
;6ÿ7ÿ 79  ÿ'ÿ 7
98ÿ
ÿ
+87 7ÿ  ÿ
ÿ
ÿ
6 "7 <ÿ=9
7ÿ98 ÿ+89 7ÿ
FINANCIAL WORKSHEET
Important Notes:
- The information provided doesn’t need to be exact and can be based in your best knowledge.
- The information unknown or that does not apply leave it blank.

PERSONAL INFORMATION
Name: Subject Property:

Dependents
Marital Status Relationship Age

INCOME INFORMATION
Income information provided is monthly

Description Debtor Co-Debtor


Earnings
Gross wages, salary and commissions
Estimated overtime
Subtotal Earnings Per Period
Deductions
Payroll Taxes and Social Security
Insurance
Union dues
Other Deductions
Subtotal Payroll Deductions
TOTAL Net Monthly Income
COMBINED Net Monthly Income
Other Income
Particular business, profession, farm, etc.
Rental from real property
Interest and dividends
Alimony, maintenance or support paymt.
Social Security or Gov. assistance
Pension or retirement income
Other monthly income
TOTAL Other Monthly Income
AVERAGE MONTHLY INCOME
COMBINED AVERAGE MONTHLY INCOME
DEBTS INFORMATION
Include total Debts of Debtors

Monthly Balance
Category Description Exempt
Payment Due
Mortgage (Subject Property)
Mortgage (Other)
Mortgage (Other)
Secured Auto Loan:
Debts Auto Loan:
Other:
Other:
Other:
Child or Marital Support
Unsecured Involuntary Cases
Contribution of employees benefits
Priority
Taxes
Debts Other:
Other:

Unsecured
Non-priority
Debts
(Credit Cards
& Loans)

Contracts &
Unexpired
Leases

TOTALS

Comments or any additional information that you think could be helpful:


EXPENSES INFORMATION
Include total expenses of Debtors

Monthly
Category Description
Payment
Rent or Home Mortgage
Real Property Taxes
Home Owners Association
Water & Power
Telephone (Home & Cell)
Household
Internet / Cable / Satellite / Other
& Utilities
Home Maintenance
Food
Clothing
Laundry & Cleaning
Medical & Dental Expenses
Transportation (Gas)
Recreation & Entertainment
Charitable Contributions
Transportation Property Insurance
& Insurance Life Insurance
Health Insurance
Auto Insurance
Other Insurance:
Auto Payments
Other Installments:
Other Installments:
Installments
Alimony, Maintenance & Support paid to others
&
Support to dependents not living at your home
Others
Regular expenses from business, profession, etc.
Other Expenses:
Other Expenses:
AVERAGE MONTHLY EXPENSES
Comments or any additional information that you think could be helpful:
012 jkl
|
34
}~
ÿ
ÿ
m672
‚
ÿÿop
ƒ
8
„…
l‡qrÿˆ‰s t4
9

†
uÿ 739
Š‹
vw
ÿ
Œ
p‡mÿ|rŽŽxyÿ‡

‚
lw2 3ÿ
m‘’ÿzw
‡“
†…
t‘{ÿw”•ÿ
 tx}yl–wŽm—|2 3ÿ

ÿÿÿ !ÿ!"ÿ#$%ÿ&ÿ'(%ÿ)'ÿ*+ÿ
1010 North Central Avenue, Glendale, CA 91202
,-.ÿ//###/+*0ÿ123.ÿNo.
41-888-755-1416
5ÿ677/+8ÿ
ÿ Tel. No. 1-888-777-9489 Fax

ÿ
ÿ
:;'<ÿ&,,<ÿ =ÿ>?:&?@<ÿ
ÿ
ABCDEFGHIÿKGLÿMGNBOEKHMBGÿKOFÿPOBQMLFLÿHBÿRBDÿKIÿKÿCBDOHFIRÿBOÿKIÿKÿIKEPSFÿSFTKSÿHFEPSKHFÿHBÿHKUFÿHBÿ
RBDOÿSBCKSÿKHHBOGFRÿOMTVHÿKWKRÿHBÿOFLDCFÿSFTKSÿNFFIXÿÿYMEFÿMIÿBNÿHVFÿFIIFGCFÿKIÿRBDÿEDIHÿHKUFÿSFTKSÿKCHMBGÿ
MGÿKÿHMEFSRÿEKGGFOÿHBÿPOBHFCHÿRBDOÿVBEFBWGFOIVMPÿOMTVHIXÿÿYVFÿKCCDOKCRÿBNÿHVFÿNKCHIÿKGLÿZÿBOÿCBGHFGHIÿBNÿ
HVFÿIKEPSFÿSFTKSÿHFEPSKHFÿKOFÿGBHÿTDKOKGHFFLÿ[DHÿCSMFGHI\ÿWVBÿVKQFÿHKUFGÿHVFIFÿHFEPSKHFIÿHBÿHVFMOÿSBCKSÿ
KHHBOGFR\ÿVKQFÿ[FFGÿIDCCFIINDSÿMGÿPDOIDMGTÿHVFMOÿB[]FCHMQFXÿ
ÿ
YVFÿSFTKSÿMGNBOEKHMBGÿPOBQMLFLÿIVBDSLÿGBHÿ[FÿCBGIHODFLÿKIÿSFTKSÿKLQMCFÿGBOÿHVFÿMGNBOEKHMBGÿBNÿKGÿ
KHHBOGFRÿCSMFGHÿOFSKHMBGIVMPXÿÿY^_`ÿMIÿGBHÿKÿSKWÿNMOEÿKGLÿMIÿGBHÿMGLMQMLDKSSRÿOFPOFIFGHMGTÿRBDÿMGÿHVMIÿKCHMBGXÿ
ÿ
aBDÿKOFÿKLQMIFLÿHBÿIFFUÿRBDOÿBWGÿKHHBOGFRÿMGÿPOFPKOMGTÿKGLÿNMSMGTÿKGRÿSFTKSÿLBCDEFGHIÿWMHVÿHVFÿCBDOHXÿÿ
Y^_`ÿWMSSÿWBOUÿWMHÿRBDOÿKHHBOGFRÿHBÿKIIMIHÿRBDÿKGLÿOFLDCFÿSFTKSÿNFFIXÿÿbSFKIFÿPOBQMLFÿHVFÿCBGHKCHÿ
MGNBOEKHMBGÿBNÿRBDOÿSBCKSÿKHHBOGFRÿHBÿRBDOÿbOBNFIIMBGKSÿcIIMIHKGHÿdbceÿKGLÿWFÿWMSSÿVKQFÿHVFEÿWBOUÿWMHVÿ
BGFÿBNÿY^_`fIÿKHHBOGFRIXÿ
ÿ
YVKGUÿRBDXÿ
gMGCFOFSR\ÿ
Y^_`ÿ
ÿ
cCUGBWSFLTFÿ[Rhÿ
ÿ
gMTGKHDOFhÿ
ÿ
bOMGHÿiKEFhÿ

Anda mungkin juga menyukai