Request for Counseling

Request for Foreclosure Counseling Form

Please fill out the form below. After submission of this form, a representative will contact you within the next 2 business days to schedule an appointment date. If you are not contacted within two business days, feel free to call us (616) 935-3270 or email us at ghhousing@grandhaven.org.

(* Required Fields)

Client Information
First Name *
Middle Initial
Last Name *
Street Address *
City *
State *
Zip Code *
Phone Number *
Last 4 digits of SSN: *
Email Address
Are you Married?
Are you Disabled?
County in which you reside? *
Current Housing Situation *
Have you owned a home within the last 3 years?
What is the GROSS Household Annual Income?*** *

***including unemployment insurance

Total number of ADULT Household Members *
Total numebr of MINORS in Household *

For statistical purposes check the appropriate answers in the check boxes below.

Ethnicity *
Gender *
Race *
Lender and Loan Information
Did an attorney's letter refer you to us? *
Is this a mobile home? *
Name of Current Servicer *
Loan Number assigned by Current Servicer *
Name of Originating Lender (if available)
Original Loan Number (if available)
How long have you owned the home? (Years) *
Total Monthly Payment (Including Taxes and Insurance) *
What is your Current Interest Rate? *
Do you have a 2nd mortgage? *
Does your name appear on the Deed and Mortgage or Land Contract?
Current Status of the Loan *
If mortgage is delinquent, what is the total amount you currently owe?
Are the property taxes delinquent? *
If YES, amount of taxes delinquent
Is your homeowners insurance delinquent?
If yes, by how much?
If the home resides on a plot of land, how big? (In acres)
Have you recieved a Demand Letter? *
If yes, when did you receive it? (Date)
Have you been notified of a Sherriff's Sale? *
What is the date of the Sherriff's Sale?
Have you filed bankruptcy within the last 2 years? *
Are you currently in bankruptcy? *
Are you currently working with an attorney? *
If yes, please provide the attorney's name and phone number
Have you refinanced within the last 3 years? *
How many times have you refinanced since you purchased the home?
Current Situation Information
What are you looking to do? *

Please describe in the text box below, the circumstance(s) that led you to contact us today. (Loss of income, more expenses, etc.)

Client Situation *
LAST QUESTION: How did you hear about our services? *
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