Contact Information

First Name:		Last Name:

Address:

City:	State:	Zip:
	- select one - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Day/Evening Phone:

Mobile Phone:

Best Time to Reach You:

- select one - Morning Afternoon Evening

Email Address:

 Additional Contact Information:

Loan Information
 

1. What type of property are you interested in financing?
   - Select One - Single Family Residence (Primary) Single Family Residence (Secondary) Co-op Condominium Town Home Mobile Home Permanent Mobile Home Movable Investment Property (Single Family) Investment Property (Multi Family) Commercial
    
2. What is the purpose of this loan?
   - Select One - Purchase (Property Identified) Purchase (Looking For A Home) Purchase (FHA Loans) Purchase (VA Loans) Refinance Refinance (Existing FHA Loans Only) Equity Loans Debt Consolidation Home Improvement Second Mortgage
   
   
3. How much cash out are you looking for?
   
   
   
4. Do you rent or own your current residence?
   - Select - Rent Own
   
    
5. If you own how much is your home worth?
   
   
   
6. What do you owe on the property currently include all mortgages?
   
   
    
7. Monthly Rent/Mortgage:
   
   
   
8. Do you prefer a fixed or adjustable rate?
   - Select - Fixed Adjustable Both
   
   
9. What is the desired term?
   - Select - 1 Year ARM 3 Year ARM 5 Year ARM 7 Year ARM 10 Year ARM 15 Year Fixed 15 Year Jumbo 20 Year Fixed 20 Year Jumbo 30 Year Fixed 30 Year Jumbo Multiple Quotes Not Sure
   
   
10. Marital Status:
    - Select - Single Single-Parent Married Separated Divorced Widowed
    
    
11. Occupation:
    
    
    
12. Company:
    
    
    
13. Current Employment Status:
    - Select - Full Time Part Time In Transition Retired Home Maker Student Other
    
    
14. How long have you been at your present job?
      Months Years
    
    
15. Are you self employed?
     Yes  No
    
    
16. What is your total monthly income? (combined, if co-borrower)
    $
    
    
17. What do your bills total each month?
    $
    
    
18. How would you rate your credit?
    - Select - Excellennt Good Fair Poor Not Sure
     
19. Have you filed for bankruptcy in the past seven years?
     Yes  No
    
    
20. Do you currently have any tax liens or judgments against you or your property?
     Yes  No