• WEALTH WATCHERS INTAKE FORM

    To better assist Wealth Watchers Inc in evaluating your situations, please fill out ALL the applicable fields below. A  Wealth Watchers Inc staff members will be in contact with you within 24 hours of completing the online form.

    If you have any questions, please do not hesitate to contact us at 904-265-4736 or at info@wealthwatchersfl.com.

  • Address of property - do not use PO Box

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  • Is Loan

  • Monthly Expenses

  • TRANSPORTATION

  • FOOD

  • INSURANCE

  • Health (medical/dental if not payroll deducted)

  • Medical
  • CHILDCARE

  • CLOTHING

  • DONATIONS

  • EDUCATION

  • GIFTS

  • PERSONAL

  • ENTERTAINMENT

  • MISCELLANEOUS

  • DEBT

  • OTHER

  • I hereby authorize Wealth Watchers, Inc to obtain/release/exchange Information from my records in order to assist me in resolving a mortgage default.
  • This information will be released only to those institutions, companies and agencies that our organization believes can provide assistance in resolving a mortgage default. Examples of such entities include mortgage servicers, mortgage investors, public agencies and other nonprofit organizations. if necessary, information of file at another entity may also be released to us. This information release/exchange will be restricted to specific financial data, such as income, budget, debt and mortgage details provided by you.
  • I understand that the provision of services at this organization is not contingent upon my decision concerning the release/exchange of information.
  • The doctrine of informed consent has been explained to me, and i understand that contents to be released/exchanged, the need for the information, and that there are statutes of regulations protecting the confidentiality of authorized information.
  • I hereby acknowledge that this consent is voluntary and is valid until such request is fulfilled. I further acknowledge that I may revoke this consent at any time except to the extent that action based on this consent has been taken. I also acknowledge that a copy of this form is as valid as the original.
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