BAI Intake Form BAI Intake FormThis form will be used to determine your eligibility in our Bankruptcy Assistance Initiative. We understand the urgency and confidentiality of the matter and will review your submission within two days. Please enable JavaScript in your browser to complete this form. - Step 1 of 4Part 1 - CLIENT INFORMATIONFull Name *FirstMiddleLastMailing Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFull Name of Spouse (if applicable)FirstMiddleLastNextPart 2 - CONTACT INFORMATIONPhone (cell/home) *Phone (work)EmailPreferred method of contact *CallTextEmailAnyNextPart 3 - PROPERTY/MORTGAGE INFORMATIONProperty AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo not forget to include the COUNTY for this address.1. How much is your mortgage payment?2. When was the last time your mortgage was paid?Month and Year3. Is the mortgage for this property in your name?YesNoI'm not sure4. Is the mortgage for this property ALSO in your SPOUSE's name?YesNoN/A5. Is the deed (title) for this property in your name?YesNoI'm not sure6. Have you received a notice of foreclosure from an attorney, law office, or mortgage company?YesNo* If YES, please attach a copy. Click or drag files to this area to upload. You can upload up to 5 files. 7. Do you need assistance filing for Chapter 13 bankruptcy (repayment plan)? *YesNo8. When is your home/property scheduled for foreclosure sale (auction)?NEXT STEPSNow that you have made this decision or are strongly considering it, PRF Institute understands the urgent timely nature of stopping the foreclosure process. Anyone considering filing for bankruptcy will need to provide the court with a list of creditors. As a next step, please provide a list of creditors’ names and addresses (no account numbers needed) on page #2. Please begin with the mortgage company attempting to foreclose on your property.NextPart 4 - CREDITOR INFORMATIONEnter the following in the spaces below for each of your creditors. This will be needed to prepare your paperwork.: 1) Creditor(s) Name and 2) Creditor(s) Address, City, State, and Zip Code** Mortgage CompanyLoans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Loans, Credit Cards, Car Payments, Medical Bills, Title Pawns, Pay Day Loans, etc.Signature and Processing Fee RequiredI understand that submitting this form alone will not stop the foreclosure process. My signature below reflects that I/we authorize PRF Institute to review the information submitted to determine my eligibility to participate in its Bankruptcy Assistance Initiative.Processing FeePrice: $ 25.00Credit or Debit Card *CardName on CardCVV/CVC Code *Zip Code * Provide the zip code associated with the billing address for this card.Your Signature *Clear SignatureSpouse's Signature (if applicable)Clear SignatureSubmit