From John Doe of XYZ Mortgage Company

I just wanted to touch base with you. My goal is to make sure you are OK during these tough times, and make sure you are getting the best deal possible on your current mortgage. It doesn't take long for me to be able to figure out if I can help you. You may contact me at 000-000-0000 so we can go over your information or fill out the form below.
 
Do you need me to contact you?
Please check a box.
  Yes
  No

Please let me know what number you would like me to call and when.
Please add the phone number you would like me to call you on and when I should call you below.
 

Would you rather me contact you at a future time?
Please add the phone number you would like me to call you on and when I should call you below.
 

Do you know of anyone who could use my services at this time?
Please add the phone number and person's name below who I may be able to help. You may also give me a short summary so I can best help them.
 

Do you have any questions about your current situation?
Please fill in the box below.