1. M O R T G A G E ASSIST A N C E R E L I E F SE R V I C ES D ISC L OSU R E
C O NSU M E R SP E C I F I C D ISC L OSU R E
C.F.R. §322 et seq.).
I MPO RT ANT NO T I C E
You may stop doing business with us at any time. You may accept or reject the
offer of mortgage assistance we obtain from your lender (or servicer). If you
reject the offer, you do not have to pay us. If you accept the offer, you will have
to pay us for our services.
(Brokerage) is not associated with the
government, and our service is not approved by the government or your lender.
Even if you accept this offer and use our service, your lender may not agree to
change your loan.
If you stop paying your mortgage, you could lose your home and damage your
credit rating.
Address of the Property
______________________________ _____________________
Date
Name of Brokerage
_________________ _____________________
Seller Date
_________________ _____________________
Seller Date
®
© 2011 Northern Virginia Association of REALTORS , Inc.
This is a suggested form of the Northern Virginia Association of REALTORS®
been exclusively printed for the use of REALTOR® and Non-Resident members of NVAR, who may copy or
otherwise reproduce this form in identical form with the addition of their company logo. Any other use of this
form by REALTOR® and Non-Resident members of NVAR, or any use of this form whatsoever by non-
members of NVAR is prohibited without the prior written consent of NVAR. Notwithstanding the above, no
REALTOR® or Non-Resident member of NVAR, or any other person, may copy or otherwise reproduce this
form for purposes of resale.
NVAR K1357 rev. 03/11

2. M O R T G A G E ASSIST A N C E R E L I E F SE R V I C ES D ISC L OSU R E
O FFER OF M ORT GAGE RELIEF
The following disclosure is made pursuant to the Federal Trade Com
C.F.R. §322 et seq.).
Letter.
I M P O R T A N T N O T I C E Before buying this service, consider the following
information:
This is an offer of mortgage assistance we obtained from your lender (or
servicer).You may accept or reject the offer. If you reject the offer, you do not
have to pay us. If you accept the offer, you will have to pay us
(same amount as disclosed previously) for our
services. If you stop paying your mortgage, you could lose your home and
damage your credit rating.
Address of the Property
______________________________ _____________________
Date
Name of Brokerage
_________________ _____________________
Seller Date
_________________ _____________________
Seller Date
®
© 2011 Northern Virginia Association of REALTORS , Inc.
This is a suggested form of the Northern Virginia Association of REALTORS®
been exclusively printed for the use of REALTOR® and Non-Resident members of NVAR, who may copy or
otherwise reproduce this form in identical form with the addition of their company logo. Any other use of this
form by REALTOR® and Non-Resident members of NVAR, or any use of this form whatsoever by non-
members of NVAR is prohibited without the prior written consent of NVAR. Notwithstanding the above, no
REALTOR® or Non-Resident member of NVAR, or any other person, may copy or otherwise reproduce this
form for purposes of resale.
NVAR K1358 rev. 03/11