1. THE LAW OFFICES OF
ANTHONY KASSAS
A Professional Law Corporation
Alternative Dispute Resolution Acceptance Package
In Process
“Integrity, Honesty, Results”
2975 REDHILL AVENUE, SUITE 100
COSTA MESA, CA 92626
Page | 1
2. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
About us
The Law Offices of Anthony Kassas is a highly regarded law firm providing client-focused,
interdisciplinary services that result in high-value legal counsel for our clients. Anthony Kassas, Esq.
founder and lead attorney at the Law Offices of Anthony Kassas has been advocating for everyday
Americans in areas that encompass the full range of consumer legal services, real estate resolution, and
default resolution. Our attorneys and staff are recognized in the industry as being insightful and innovative
leaders in their respective areas of practice.
Excellence
As a law firm that realizes the direct impact we can have on the quality of life of each and every one of our
clients, we are absolutely committed to go above and beyond for them and are determined to resolve the
urgent legal matters they face. We execute this promise with excellence and integrity and by setting an
exceptionally high standard of service and quality for each member of our team. Every member of The
Law Offices of Anthony Kassas family is asked to take a Pledge of Excellence where they resolve to
uphold and abide by following The Law Offices of Anthony Kassas core company values: Honesty,
Respect, Timeliness, Diligence, Integrity, Empathy and Compassion.
Commitment and Ethics
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From Legal Assistants to Veteran Attorneys, every staff member at the The Law Offices of Anthony
Kassas prides themselves on their unwavering commitment to serve clients well, being responsive, and
conducting business and legal matters in accordance to the standards and code of ethics set forth by the
California State Bar.
Customer Relationships
At the Law Offices of Anthony Kassas we strive to be a partner for each client throughout the course of
their legal matter, answering any of their questions, doubts or concerns, so that they have a comfortable and
comprehensive understanding of the entire process. Functioning as a symbiotic team, the The Law Offices
of Anthony Kassas harnesses the combined experienced possessed by attorneys and staff to provide
valuable direction and advice for clients.
Diversity
Our firm is dedicated to cultivating an environment that embraces diversity reflective of our clients and our
communities. Our commitment to building teams that mirror the rich cultural backgrounds of the
communities in which we practice is another way in which we truly add value and real-world
understanding to our client relationships.
Charity
The Law Offices of Anthony Kassas is also committed to being engaged in the communities in which we
live and work. Whether providing pro-bono legal services or volunteering at local charities, we encourage
our attorneys to devote time, energy, and insights to the communities that we call home through active
community involvement.
The Law Offices of Anthony Kassas is truly dedicated to the interests of our clients, our people, and our
communities. We strive to address their needs and meet their expectations efficiently and effectively —
with our core values always at heart: Honesty, Respect, Timeliness, Diligence, Integrity, Empathy and
Compassion
CA State Bar Lic. # 227647
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3. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
Case Intake
The Law Offices of Anthony Kassas requires that all prospective clients have a conference call with one of
our Compliance Officers. Please note that The Law Offices of Anthony Kassas does not agree to represent
you and will not begin representation until this conference call has taken place.
Upon receipt of your completed Acceptance Package, Compliance Officer will contact you. Please identify
the best time (between 9:00 am – 5: pm PST, Mon – Fri) and the number to call below:
Best Contact Person: __________________________
Charlie Abayan
Phone Number: ______________________________
7606726571
Email:______________________________________
Charlie.Abayan@yahoo.com
Please help us reach you:
Clients Co - Clients
Charlie Abayan
In Process
Name: _______________________________________
Date: ________________________________________
7/21/2011
Name: _____________________________
Date: ______________________________
7/21/2011
Address: _____________________________________
647 Atherton Address: ____________________________
647 Atherton
_____________________________________
San Marcos, CA 92078 ____________________________
San Marcos, CA 92078
Home Phone Number: ___________________________
7606726571 Home: ____________________________
7606726571
Cell Phone Number: ____________________________ Cell: ____________________________
E-mail Address: _______________________________
Charlie.Abayan@yahoo.com E-mail: ____________________________
True Retainer Paid: _____________________________
5,500.00
Lender, 1 st: CHASE LOAN #:
Lender, 2 nd : LOAN #:
Notice of Sale: Yes No Date: ____________
Notice of Default: Yes No Date: ____________
Previous BK: Yes No
Once again thank you for choosing The Law Offices of Anthony Kassas, We look forward to representing
you.
CA State Bar Lic. # 227647
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4. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
KASSAS LAW GROUP CORP. ( ". LG‖) and Charlie Abayan
K _________________(Client‖) hereby agree that
KLG will provide limited legal services to Client as set forth below.
CONDITIONS This Agreement will not take effect, and KLG will have no obligation to provide
services, until Client returns a signed copy of this Agreement and provides KLG with requested
documentation and conducts phone interview with investigative research department as described
below.
SCOPE OF SERVICES Client hires Attorney to provide legal services in the following matters
only: Alternate Dispute Resolution representation in connection with the loan(s) made by
______________________________________________________________________________
CHASE
______________________________________________________________________________
(Lender(s)‖) and secured against Client’s property located at:
_______________________________________________________________(the Property‖).
647 Atherton San Marcos, CA 92078
(a) Fact Investigation – All actions to investigate and understand the facts of matter,
including
a. Interviews with clients, brokers, lenders, bank employees, and potential
In Process
witnesses
b. Identification and verification of all appropriate parties, including identification,
personal searches and letters of authority
c. Review documents to learn facts about the case
d. Consultations and Investigations
e. All related communications and correspondence, including e-mail and
teleconferences
(b) Case Analysis, Development of Case Strategy – The thinking, strategizing, and
planning for a case, including
a. Discussions, writing, and meeting case strategy
b. Legal research for case assessment purposes, for developing an initial theory of
case, and basic case strategy
c. Preparation of written opinion, if required or appropriate
(c) Discovery
a. Disposition Analysis (DA)
i. Review and Analyze information provided by client
ii. Prepare (DA) report containing results and analysis
_______ / _______
CA State Bar Lic. # 227647
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5. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
iii. Reasonable efforts to ensure that (DA) is current with respect to all
applicable federal guidelines and policies
b. Gathering of documents, including electronic and original records
c. Reviewing and identifying documents for production
d. Reviewing documents for privilege, making and responding to privilege claims
e. Preparation of Affidavits of Documents
f. Responding, objecting to, and negotiating requests for production of documents
(d) Offers to Settle, Settlement, and Alternative Dispute Resolution (ADR) -
All settlement activities, including
a. Planning for participating in formal and informal settlement discussions, four-
way meeting, conferences, and hearings
b. Alternate Dispute Resolution demand letters and ensuring discussions
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c. Drafting offers to settle, reviewing offers to settle from opponents
d. Implementing a settlement
DUTIES OF ATTORNEYS AND CLIENT Attorneys shall provide legal services reasonably
required to represent client in this matter as described in paragraphs (a) through (d) of this
agreement. All services listed in sections (a) through (d) may or may not be used at the discretion
of the attorney(s) as to their implementation and usage. Attorney shall also take reasonable steps
to keep Client informed of significant developments and have the attorney or a member of his
staff respond to the client’s inquiries.
Client shall be truthful with Attorneys, cooperate with Attorneys, keep Attorneys informed of
developments, perform the obligations Client has agreed to perform under this Agreement, pay
Attorney’s bills within (30) days of being rendered, and keep Attorneys apprised of Client's
address, telephone number and whereabouts.
FIXED SERVICE FEE Client agrees to pay a fixed fee of $ 5,500.00 for KLG’s Services under
this Agreement and are considered earned in full upon lenders response or failure to respond in
the time allotted (60 days) per agreement. The fees and disbursements are payable regardless of
the result unless a special arrangement has been made between the lawyer and the client. Lawyers
and clients may make special arrangements for
1. Fees driven in whole or part by the result
2. A success bonus in the case of a satisfactory result
If Client fails to pay for services provided, Attorney will consider failure to pay a breach of
contract and shall withdraw from further representation
_______ / _______
CA State Bar Lic. # 227647
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6. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
LITIGATION SERVICES NOT INCLUDED This Agreement does not cover litigation
services of any kind, whether in court, arbitration, administrative hearings and no such services
contemplated or implied by this Agreement. Should client desire to hire KLG or Affiliate
Attorney for litigation services, those services will be offered under a separate agreement for an
additional $ 1,750.00 retainer contribution and $ 300.00 monthly servicing fee.
This Agreement does not cover other related claims that may arise and may require legal
services, such as: lender lawsuits, negotiation of deed in lieu of foreclosure, defense of
foreclosure actions and other foreclosure related activities, or to provide any tax advice.
Client does not expect Attorney to represent Client in any lawsuit, file a bankruptcy
petition for Client, or to intervene in any foreclosure proceeding and/or stop any
foreclosure proceeding if one is pending. If Client determines Client needs legal
representation in any court proceeding, foreclosure proceeding, or bankruptcy, or for any
state specific issue, Client will retain an attorney at Client’s expense.
Client further understands and agrees that Attorney has no obligation to provide any
In Process
additional legal services until Client pays the fees in full and no contract exists to
represent client until a new retainer has been executed between both parties.
ERRORS AND OMMISSIONS INSURANCE KLG does maintain Professional Liability
Insurance with respect to the legal services provided under this agreement.
ARBITRATION CLAUSE any controversy between the parties regarding the construction,
application or performance of any services under this Agreement, and any claim arising out of or
relating to this Agreement or its breach, shall be submitted to binding arbitration with JAMS
arbitration services upon the written request of one party after the service of that request on the
other party. The parties shall appoint one arbitrator from JAMS to hear and determine the dispute
and the arbitration shall be conducted pursuant to JAM’s arbitration rules. If the parties cannot
agree, then the Superior Court of Orange County shall choose an impartial arbitrator whose
decision shall be final and conclusive on all parties. Attorney and Client shall each have the right
of discovery in connection with any arbitration proceeding in accordance with Code of Civil
Procedure Section 1283.05. The parties shall bear their own legal fees and costs for all claims.
The sole and exclusive venue for the arbitration and or any legal dispute shall be Orange County,
California.
STATE BAR FEE ARBITRATION Notwithstanding paragraph 9 above, in any dispute subject
to the jurisdiction of the State of California over attorney’s fees, charges, costs or expenses,
Client has the right to elect arbitration pursuant to the fee arbitration procedures of the State Bar
of California, as set forth in California Business and Professions Code Section 6200, et seq.
Those procedures permit a trial after arbitration, unless the parties agree in writing, after the
dispute has arisen, to be bound by the arbitration award.
_______ / _______
CA State Bar Lic. # 227647
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7. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
If, after receiving a notice of Client’s right to arbitrate, Client does not elect to proceed under the
State Bar fee arbitration procedures, and file a request for fee arbitration within 30 days, any
dispute over fees, charges, costs or expenses, will be resolved by binding arbitration as provided
in paragraph 9.
ENTIRE AGREEMENT This Agreement constitutes the entire understanding between KLG
and Client. This Agreement can only be modified in writing, signed by both KLG and Client.
The laws of the State of California govern the construction and interpretation of this agreement.
The venue for any legal action or arbitration arising from a breach of this agreement shall be
Orange County, California, USA.
DISCLAIMER OF GUARANTEE Nothing in this Agreement and nothing in KLG’s statements
to Client will be construed as a promise or guarantee about the outcome of the matter. KLG
makes no such promises or guarantees. KLG’s comments about the outcome of the matter are
expressions of opinion only.
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THE PARTIES HAVE READ AND UNDERSTOOD THE FOREGOING TERMS AND
AGREE TO THEM AS OF THE DATE THE LAW OFFICES OF ANTHONY KASSAS
PROVIDED SERVICES. IF MORE THAN ONE CLIENT SIGNS BELOW, EACH AGREES
TO BE LIABLE, JOINTLY AND SEVERALLY, FOR ALL OBLIGATIONS UNDER THIS
AGREEMENT. CLIENT SHALL RECEIVE A FULLY EXECUTED DUPLICATE OF THIS
AGREEMENT.
X__________________________ ____________
Charlie Abayan Date
X__________________________ ____________
Date
CA State Bar Lic. # 227647
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8. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
Charlie Abayan
Name: _______________________
647 Atherton
Address: _______________________
City/State/Zip: San Marcos, CA 92078
_______________________
7606726571
Telephone number: _______________________
To: _______________________
Address: _______________________
City, State, Zip: _______________________
7/21/2011
Date: _______________________
Re: Loan Number: _______________________
Legal Department
Dear _______________________,
CHASE
In Process
_______________________ is the servicer of my mortgage loan at the above address. I dispute
the amount that is owed according to the Monthly Billing Statement and request that you send to
me information about the fees, costs and escrow accounting on my loan. I dispute that my
account should be in default or foreclosure.
I also dispute your reporting of this account to the credit reporting agencies. This is a “qualified
written request” pursuant to the Real Estate Settlement and Procedures Act (section 2605(e)).
Because of this dispute, I am requesting all of the following information:
1. A complete and itemized statement of the loan history from the date of the loan to the date of
this letter including, but not limited to, all receipts by way of payment or otherwise and all
charges to the loan in whatever form. This history should include the date of each and every
debit and credit to any account related to this loan, the nature and purpose of each such debit and
credit, and the name and address of the payee of any type of disbursement related to this account.
2. A complete and itemized statement of all advances or charges against this loan for any
purpose that are not reflected on the loan history transaction statement provided in answer to
question #1.
3. A complete and itemized statement of the escrow account of the loan, if any, from the date of
the loan to the date of this letter, including, but not limited to, any receipts or disbursements with
respect to real estate property taxes, fire or hazard insurance, flood insurance, mortgage
insurance, credit insurance, or any other insurance product.
CA State Bar Lic. # 227647
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9. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
4. Have you purchased and charged to the account any Vendor’s Single Interest Insurance?
5. A complete and itemized statement from the date of the loan to the date of this letter of any
forced-placed insurance and expenses related thereto, related in any way to this loan.
6. A complete and itemized statement from the date of the loan to the date of this letter of any
suspense account entries and/or any corporate advance entries related in any way to this loan.
7. A complete and itemized statement from the date of the loan to the date of this letter of any
property inspection fees, property preservation fees, broker opinion fees, appraisal fees,
bankruptcy monitoring fees, or other similar fees or expenses related in any way to this loan.
8. Identify the provision under the mortgage or note that authorizes charging each and every such
fee against the loan of the debtors.
In Process
9. Please attach copies of all property inspection reports and appraisals.
10. A complete copy of any key loan transaction report or reports and any reports indicating any
charges for any "add on products" sold to the debtors in connection with this loan from the date
of the loan to the date of this letter.
11. A complete and itemized statement of any and all arrears including each month in which the
default occurred, and the amount of each monthly default.
12. A complete and itemized statement of any late charges to this loan from the date of this loan
to the date of this letter.
13. The amount, if applicable, of any “satisfaction fees.”
14. A complete and itemized statement from the date of the loan to the date of this letter of any
fees incurred to modify, extend, or amend the loan or to defer any payment due under the terms
of the loan.
15. The current amount needed to pay-off the loan in full.
16. A full and complete comprehensible definitional dictionary of all transaction codes and other
similar terms used in the statements requested above. The list of transaction codes should have
an explanation of each code in plain English clearly stating the meaning of the code.
CA State Bar Lic. # 227647
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10. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
17. A complete and itemized statement of any funds deposited in any suspense account(s) or
corporate advance account(s), including, but not limited to, the balance in any such account or
accounts and the nature, source and date of any and all funds deposited in such account or
accounts.
18. A complete and itemized statement from the date of this loan to the date of this letter of the
amount, payment date, purpose and recipient of all foreclosure expenses, NSF check charges,
legal fees, attorney fees, professional fees and other expenses and costs that have been charged
against or assessed to this mortgage.
19. A complete and itemized statement of the amount, payment date, purpose and recipient of all
fees for the preparation and filing of the original proof of claim, any amended proofs of claim or
any supplemental proofs of claim in this case.
In Process
20. The full name, address and phone number of the current holder of this debt including the
name, address and phone number of any trustee or other fiduciary. This request is being made
pursuant to Section 1641(f)(2) of the Truth In Lending Act, which requires the servicer to
identify the holder of the debt.
21. The name, address and phone number of any master servicers, servicers, sub-servicers,
contingency servicers, back-up servicers or special servicers for the underlying mortgage debt.
22. A copy of any mortgage Pooling and Servicing Agreement and all Disclosure Statements
provided to any Investors with respect to any mortgage-backed security trust or other special
purpose vehicle related to the said Agreement and any and all Amendments and Supplements
thereto.
23. If a copy of the Pooling and Servicing Agreement has been filed with the SEC, provide a
copy of SEC Form 8k and the Prospectus Supplement, SEC Form 424b5.
24. The name, address and phone number of any Trustee under any pooling or servicing
agreement related to this loan.
25. A copy of the Prospectus offered to investors in the trust.
26. Copies of all servicing, master servicing, sub-servicing, contingency servicing, special
servicing, or back-up servicing agreements with respect to this account.
CA State Bar Lic. # 227647
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11. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
27. All written loss-mitigation rules and work-out procedures related to any defaults regarding
this loan and similar loans.
28. The procedural manual used with respect to the servicing or sub-servicing of this loan.
29. A summary of all fixed or standard legal fees approved for any form of legal services
rendered in connection with this account.
30. Is this loan subject to any Electronic Tracking Agreement? If the answer is yes, then state the
full name and address of the Electronic Agent and the full name and address of the Mortgage
Electronic Registration System.
31. Is the servicing of this loan provided pursuant to any type of mortgage electronic registration
system? If the answer is yes, then attach a copy of the mortgage electronic registration system
procedures manual.
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32. A copy of the LSAMS Transaction History Report for the debtors’ mortgage loan account,
with a detailed description of all fee codes.
33. Is this a MERS Designated Mortgage Loan? If the answer is yes, then identify the electronic
agent and the type of mortgage electronic system used by the agent.
34. Is this mortgage part of a Mortgage Warehouse Loan? If so, then state the full name and
address of the Lender and attach a copy of the Warehouse Loan Agreement.
35. Upon any default or notice of default, state whether or not the Mortgage Warehouse Lender
has the right to override any servicers or sub-servicers and provide instructions directly to the
Electronic Agent? If the answer is yes, then specifically identify the legal basis for such
authority.
36. Is this mortgage part of a Whole Loan Sale Agreement? If the answer is yes, then state the
name and address of the Purchaser, the Custodian, the Trustee, the Electronic Agent and any
Servicer or Sub-Servicers.
37. Please state the full name and address of any attorney you have retained to provide any legal
services in this case at any time post-petition.
CA State Bar Lic. # 227647
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12. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
38. Please provide copies of all the documents we signed at the closing of this loan.
You should be advised that you must acknowledge receipt of this qualified written request within
5 business days, as amended by the Dodd Frank Financial Reform Act, pursuant to 12 U.S.C.
Section 2605(e)(1)(A) and Reg. X Section 3500.21(e)(1) and provide all requested information
and documents within 30 days.
You should also be advised that I will seek the recovery of damages, costs, and reasonable legal
fees for each failure to comply with the questions and requests herein. I also reserve the right to
seek statutory damages for each violation of any part of Section 2605 of Title 12 of the United
States Code.
I trust you will govern yourselves accordingly.
Sincerely yours,
In Process
Law Office of Anthony Kassas
X__________________________ ____________
Charlie Abayan Date
X__________________________ ____________
Date
CA State Bar Lic. # 227647
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13. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
By Initialing Below, I hereby acknowledge and understand the following and am aware that should any agent, contractor, affiliate, a
employee, or otherwise have inadvertently, accidentally, willfully or otherwise communicated anything contrary to the following, I
understand that their statements are erroneous, incorrect and the the advice, recommendation nor policy of The Law Offices of
Anthony Kassas (KLG).
A. I have not been advised to breach or forego any agreement between the defendant
which may adversely affect my current financial situation or standing. Initial _____
B. I understand that alternate dispute resolution does not restrict or prevent any party from the Initial _____
collection of a valid debt bound by any valid contractual agreement.
C. I have been informed by The Law Offices of Anthony Kassas they cannot predict the outcome Initial _____
of its attempt to settle the legal dispute and no guarantee’s have been given regarding any
specific outcome.
D. I understand that The Law Offices of Anthony Kassas requires that all prospective clients Initial _____
have a Compliance Call with the attorney or attorney’s staff assigned to their case. I
understand that until such call takes place, KLG does not agree to represent me and will not
E.
In Process
begin representation. I understand that the attorney client relationship only begins once
both the clients, and attorney has signed the retainer agreement.
I understand that: Representation with KLG is limited solely to the services set forth in this Initial _____
Retainer agreement and any further representation would require the execution of a
separate retainer and agreement.
F. I understand that I am not hiring KLG to file a Lawsuit but to mediate and arbitrate on my Initial _____
behalf for the purposes of receiving proposed settlement terms.
G. I understand that KLG has not agreed to represent me in any foreclosure or bankruptcy Initial _____
proceedings or to perform individual litigation services of any kind.
H. I understand that I am paying for the evaluation, discovery and presentation of my case. Initial _____
Settlement offers will be demanded based on strength of the case but are not guaranteed and
will take a minimum of 60-90 days.
I. I further understand that if KLG does not reach settlement within 90 days of demand being Initial _____
Issued to lender KLG or affiliate attorney may choose to proceed to litigation at an additional
fee under a separate retainer agreement.
J. I must make every attempt to work with and provide all the necessary documents to KLG. Initial _____
If I should fail to provide such information I understand that it will be deemed a breach of
The working relationship and thus may forfeit and all legal fees paid to KLG.
__________________________
Charlie Abayan ___________________________________ ______________
Client Name ( Please Print ) Client Signature Date
CA State Bar Lic. # 227647
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14. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
Borrower's Authorization
Lender Name: CHASE Loan Number:
Customer(s) Property Address: 647 Atherton San Marcos, CA 92078
THIRD PARTY AUTHORIZATION AND RELEASE FORM
Authorized Third Party Information
Company Name: Law Office of Anthony Kassas
Third Party Contact Name: Anthony Kassas, John Jay Lebron, Denny Lake, Barry Gabster, Malcolm Turner, Paul Petersen,
Michelle Lefoaseu, Chris Gunaratna, Gardenia Astudillo, Elvia Meza, Balbina Mendoza,
Jennifer Cornejo, Tracy Wheeler, Miguel Nunez, Dayanara Munoz, Elaine King
Mailing Address: 2975 Redhill Avenue, Suite 100, Costa Mesa, CA 92626
Phone Number: (714) 617-7937
______ Loan Pay off Statement ______ Loan History Escrow and Payment
______ Escrow Analysis ______ Short Sale or Loan Modification
______ Payment or Repayment Plans ______ Foreclosure or Bankruptcy
______ Document Copies
Other/Comments:
In Process
No restrictions on any information necessary to service the account
If this received by the wrong department, please forward to the appropriate authorization department
or call our office listed below.
This section must be completed by the customer(s)
I/We hereby authorize CHASE to discuss the above information on the referenced
loan to the designated third party or company.
Primary Customer authorization:
____________________________________
Charlie Abayan Date
Contact Phone Number: 7606726571 Contact Cell Number:
Social Security Number:
Secondary Customer authorization:
____________________________________ Date
Contact Phone Number: 7606726571 Contact Cell Number:
Social Security Number:
After receipt, please allow two business days for the referenced loan account to be update for third party
authorization.
Anthony Kassas - Third Party Authorization Office # (714) 617 - 7937
2975 Redhill Ave, Suite 100, Costa Mesa CA 92626 Fax # (888) 881 - 4157
We respect and support the privacy, security, and confidentiality of your personal information.
CA State Bar Lic. # 227647
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15. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
ACCOUNT METHOD OF PAYMENT
Name : HOD OF PAYMENT
Charlie Abayan
_______________________________________ Charlie.Abayan@yahoo.com
Email: _______________________________
Address : ___________________________________________________________________________________
647 Atherton
San Marcos
City : _________________________________________ CA
ST : ________ 92078
Zip : _________________
7606726571
Home Tel # : ___________________________________ Cell # : _____________________________
PAYMENT # 1 DUE DATE : 7/31/2011 AMOUNT $ 2,000.00 INITIAL :
PAYMENT # 2 DUE DATE : 8/31/2011 AMOUNT $ 2,000.00 INITIAL :
PAYMENT # 3 DUE DATE : 9/30/2011 AMOUNT $ 1,500.00 INITIAL :
PAYMENT # 4 DUE DATE : AMOUNT $ INITIAL :
In Process
Personal Checking Business Checkings Cashier’s Check Savings
SIGNATURE : DATE :
FULL NAME AS IT APPEARS ON THE CHECK : Charlie Abayan
16. Law Offices of Anthony Kassas
A Law Firm Specializing in Consumer Disputes
ACH Authorization Form
All Information on this form is required unless otherwise noted
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In Process San Marcos
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