SAMPLE Foreclosure Mitigation Counseling Agreement



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707 Quitman, Houston, TX 77009

Phone: 713-864-9099 Fax: 713-864-0027



Letter of Authorization, Disclosure Statement

And Description of Avenue CDC’s Services

I,___________________________________, authorize ________________________, a counselor with Avenue Community Development Corporation (Avenue CDC) to provide__________________________(prepurchase, postpurchase, homeless, renovation, rehabilitation, foreclosure and renovation counseling on my behalf. I authorize Avenue CDC to release any and all information regarding my loan and finances to any person or firm Avenue CDC deems necessary in assisting me, including driver’s license or authorized photo ID, paystubs, contract, HUD-1, and I agree to hold Avenue CDC harmless for such release.

I authorize _______________(counselor) to discuss my loan and finances with Avenue CDC.

I understand that Avenue CDC receives Congressional funds through Neighborworks America, National Foreclosure Mitigation Counseling (NFMC) and HUD (Housing and Urban Development) programs and, as such, is required to share some of my personal information with program administrators or their agents for purposes of program monitoring, compliance and evaluation. I give permission to the above mentioned administrators or their agents to follow-up with me for the purposes of program evaluation. I acknowledge that I have received a copy of Avenue CDC’s Privacy Policy.

I understand that a counselor may answer questions and provide information, but not give legal advice. If I want legal advice, I will be referred for appropriate assistance.

I understand that Avenue CDC provides information and education on many loan products, professional services, and housing programs. Avenue CDC provides pre-purchase and post-purchase homebuyer education and counseling, foreclosure prevention counseling, develops affordable for-sale homes, provides subordinate loans, develops and manages affordable rental housing and provides supportive services, and promotes economic development and community building. Avenue CDC has received and may continue to receive funding from various corporations, including: Amegy Bank of Texas, Bank of America, Bank of Texas, Capital One, Citigroup, JP Morgan Chase, Mercantile Commercebank, Northern Trust, State Farm, Wells Fargo, and Whitney National Bank. I understand that the housing counseling I receive from Avenue CDC in no way obligates me to choose any particular loan products or housing programs or services.

LENDERS/SERVICERS:

Please inform Avenue CDC of all information you will require. The Avenue CDC Counselor will email and/or fax all the necessary documentation.

Avenue CDC contact information is:

Avenue CDC

707 Quitman Phone: 713-864-9099

Houston, Texas 77009 Fax: 713-864-0027

Counselors Email: Monikag@

Lizbethm@

Dianej@

Rosag@

Davidr@

I acknowledge that this authorization will begin on (date) __________ and will remain in effect until _________________. I also acknowledge that if I want to terminate this authorization I will notify you in writing.

Client’s signature____________________________

Date______________________________________

Avenue CDC Privacy Policy

Avenue CDC understands that the concerns you bring to us are highly personal in nature. Your “nonpublic personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to lenders, creditors, program monitors, and others with your authorization and signature on the Letter of Authorization, Disclosure statement, and Description of Avenue CDC services. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs.

Types of information that we gather about you

• Information we receive from you orally, on applications or other forms, such as your name, address, social security number, assets, and income;

• Information about your transactions with us, your creditors, or others, such as your account balance, payment history, parties to transactions and credit card usage; and

• Information we receive from a credit reporting agency, such as your credit history.

You may opt-out of certain disclosures

1. You have the opportunity to “opt-out” of disclosures of your nonpublic personal information to third parties (such as your creditors), that is, direct us not to make those disclosures.

2. If you choose to “opt-out”, we will not be able to answer questions from your creditors. If at any time, you wish to change your decision with regard to your “opt-out”, you may call us at 713-864-9099, ext. 234and do so.

Release of your information to third parties

1. So long as you have not opted-out, we may disclose some or all of the information that we collect, as described above, to your creditors or third parties where we have determined that it would be helpful to you, would aid us in counseling you, or is a

requirement of grant awards which make our services possible.

2. We may also disclose any nonpublic personal information about you or former customers to anyone as permitted by law (e.g., if we are compelled by legal process).

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