Please complete the following:

Personal Information

Please help us understand your current employment situation.

Borrower Certification and Agreement

1. I certify and acknowledge that the information in this Mortgage Assistance Application is true and correct to the best of my knowledge.
2. I acknowledge that that Focus Federal Credit Union is not obligated to offer assistance based solely on the representations in this document.
3. I consent to being contacted concerning this application at any telephone number, including mobile phone, or email address I have provided to Focus Federal Credit Union.
4. I acknowledge that if I have an escrow account associated with my mortgage payment that a deferment of the total payment including my escrow portion, may cause an increase in the total mortgage payment once the annual escrow review has been completed.
5. I acknowledge that any modification to my current mortgage is solely to extend the period of repayment and that the original terms of my mortgage will be changed as a result of the modification.
6. Borrower's signature:*
7. Date*
   MM slash DD slash YYYY
8. Joint borrower's signature
9. Date
   MM slash DD slash YYYY

10. Please submit your completed application to [email protected] or fax to 405-488-2818.

11. Name
    This field is for validation purposes and should be left unchanged.