Continentalpublicbank.com



2476500-205740CONTINENTAL PUBLIC BANK DEBT RELIEF REQUESTName: _____________________________ Date: ______________________ CONTACT INFORMATION: STATUS: Address: ___________________________ American National _____ ___________________________ ___________________________ State resident _____Email: ___________________________ U.S. citizen _____Phone(s): ____________________________ PMA: _________________________________NAC: _______________________________ DOB: _________________________________TYPE OF ASSISTANCE REQUESTED: Mortgage ______ Vehicle______ ITEMS NEEDED PRIOR TO SUBMISSION:MORTGAGE: Payment in full for the cost of printing the total Continental Dollars required for Debt Relief. Payment in full for flat-rate recording, processing and administrative costs.Current mortgage statement inclusive of lienholder.Current property tax statement.Verified pay-off amount.Description of property.Allow thirty-five days from submission to payoff date.VEHICLE:Payment in full for the cost of printing the Continental Dollars required for Debt Relief.Payment in full for flat-rate recording, processing and administrative costs.Current statement.Verified payoff amount.Title and current registration.Allow thirty-five days from submission to payoff date.Amount Requested: _____________________ Business/Venture Plan In Place** Yes _____ No ______ Additional Parties**:__________________________________________________________________________** Attach Additional Documentation as Needed/RequiredBy: ______________________________________ Date: _______________________________________ ................
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