Schedule Form for Reverse Mortage

Borrower Names	DOB

Address:

City

State:

Zip Code:

Borrower's Phone:

Home Value:

Liens Against Home:

(Include outstanding mortgage.)

Language Spoken? English: Spanish: Other:

Best time to reach you? 8-12: 12-5: after 5: anytime:

If you would like us to send a copy of your certificate to your broker upon completion of your counseling, please provide the following information:

Broker Name:

Company:

Phone:

Fax:

Broker Email:

In accordance with HUD guidelines, there is a fee for HECM counseling. Smart Money Housing charges $125 for HECM counseling. The fee may be paid up-front at the time of counseling or it may be financed into your reverse mortgage. If you do not obtain a reverse mortgage you will receive an invoice for payment.

Please enter Submit code in the box below: 861701608

Submit Code: