United Financial Solutions Group Service Agreement

Please answer these questions to the best of your ability.  The more information you can provide here the better your chances of getting pre-qualified for the HAMP program.

 I   (primary borrower) pay mortgage to for my residence 

located at  City  State Zip  

Referred by

I would like to get started on (mm/dd/yy)

Payment arrangements (Choose 1)

  I would like to Pay in full $1495.00

  I would like to Pay $750.00 with a 2nd payment $745.00 on

Name on card Billing Address if different than above

Card number Expiration date (mm/yy) 3 digit code on back of card

Money Gram/Account Now Instructions are listed below in the agreement

I agree to the terms and conditions of this agreement.

Email address

Signature Date (mm/dd/yyyy)

You will receive a copy of this agreement within the next 24 hours via email.


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