Call ID   Date  
 
Contact
Name
Address 1
Address 2
City
State Zip
Phone 1 Province
Phone 2 Fax
E-Mail
Loan Info
Current Loan Balance
Interest Rate
Monthly Payments
Lender
Default Notice?
How Far Behind?
ARM?
Reset
Decision Maker?
 
Employment
Employed
Type of Work
Approx Monthly Income
Spouse Income
Can Make Monthly Payments
How Much
   
Call Center Agent
Time Called Time Completed
Agent Comments

Loan Mod Counselor
Flagged
Call Center Comments
Counselor Comments