What is your current mortgage owing?

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Are you behind on payments?

Yes, 30 Days

Yes, 30 - 60 Days

Yes, 60 - 90 Days

Yes, 90+ Days

No

What is the current estimated value of the property you wish to remortgage?

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What is the property address?

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What is your Employment Status?

Employed

Self Employed

Retired

Disability

Other

Unemployed

How much unsecured debt do you have?

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Briefly describe your debt problem:

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Do you have a second mortgage?

No

Yes

What is your credit rating?

Excellent

Good

Fair

Poor

I Don't Know

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