Foreclosure Fairness Act (FFA)

Individualized Agreement Reporting Form

Foreclosure Prevention Fee

Washington State Department of Commerce, Foreclosure Fairness Program


Pursuant to Chapter 61.24 RCW


Please only complete this report if you have an approved Individualized Agreement Application on file.

 

Entity Name

 

Entity name should match the name listed on your Individualized Agreement Application.

 
 

Point of Contact Details

 
 
 
 
 
 
Phone
 
 
 

Reporting Period

 

Selected remittance frequency should match the selection on your Individualized Agreement Application.

 
 

Data

 
 
 
 
 

Confirmation

 

By checking this box, I acknowledge this form is complete and accurate to the best of my knowledge.