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Loan Revival LLC
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Intake form
Help us serve you better
Name
*
Email address
*
What is your current housing situation?
Select
Renting
Homeowner
Living with family/friends
Are you currently facing financial difficulties?
Select
Yes
No
What type of assistance are you interested in?
Please select at least one option.
Rent-Back Option
Buyback Pathway
Cash for Keys
Credit Repair Assistance
What is your preferred method of communication?
Select
Email
Phone
Text
What is your current mortgage status?
Select
Current
Late
In Pre-Foreclosure
Foreclosure
Have you previously sought assistance for your situation?
Select
Yes
No
If yes, please describe the assistance you sought.
What is your estimated timeline for resolution?
Select
Immediate
1-3 months
3-6 months
6+ months
Do you have any specific concerns or questions?
Which service or services are you interested in?
Please select at least one option.
Rent-back options
Buyback pathway
Cash for keys
Equity partnership program
Additional questions or comments
Submit
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