APPLICANT INFORMATION
Applicant's first name*   Applicant's last name *   Applicant's e-mail*        Co-applicant's first name Co-applicant's last name Co-applicant's e-mail
ADDRESS
ADDRESS 2
CITY
STATE	(please select) AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
POSTAL CODE
CONTACT INFORMATION
HOME PHONE		-
WORK PHONE		- Ext:
WHAT IS BEST TIME TO CONTACT YOU		Late Evening at Home Evening at Home Afternoon at Home Afternoon at Work Morning at Home Morning at Work
LOAN INFORMATION
TYPE OF LOAN DESIRED		(please select) Second Mortgage Purchase Refinance Refinance - Cash Out Home Improvement Debt Consolidation
LOAN AMOUNT DESIRED		Please Select50,000 - 60,00060,000 - 70,00070,000 - 80,00080,000 - 90,00090,000 - 100,000100,000 - 110,000110,000 - 120,000120,000 - 130,000130,000 - 140,000140,000 - 150,000150,000 - 160,000160,000 - 170,000170,000 - 180,000180,000 - 190,000190,000 - 200,000200,000 - 225,000225,000 - 250,000250,000 - 275,000275,000 - 300,000300,000 - 325,000325,000 - 350,000350,000 - 375,000375,000 - 400,000400,000 - 425,000425,000 - 450,000450,000 - 475,000475,000 - 500,000500,000 - 550,000550,000 - 600,000600,000 - 650,000650,000 - 700,000700,000 - 750,000750,000 - 800,000800,000 - 850,000850,000 - 900,000900,000 - 950,000950,000 - 1000,0001,000,000 - 1,100,0001,100,000 - 1,200,0001,200,000 - 1,300,0001,300,000 - 1,400,0001,400,000 - 1,500,0001,500,000 - 1,600,0001,600,000 - 1,700,0001,700,000 - 1,800,0001,800,000 - 1,900,0001,900,000 - 2,000,0002,000,000 - 2,100,0002,100,000 - 2,200,0002,200,000 - 2,300,0002,300,000 - 2,400,0002,400,000 - 2,500,0002,500,000 - 2,600,0002,600,000 - 2,700,0002,700,000 - 2,800,0002,800,000 - 2,900,0002,900,000 - 3,000,0003,000,000 - 3,250,0003,250,000 - 3,500,0003,500,000 - 3,750,0003,750,000 - 4,000,0004,000,000 - 4,250,0004,250,000 - 4,500,0004,500,000 - 4,750,0004,750,000 - 5,000,000
Subject PROPERTY INFORMATION
TYPE OF HOME OWNED		(please select) Single Family Detached Home Condo/Townhouse Multi-Family Dwelling Unit Double Wide Manufactured Home Single Wide Manufactured Home
CURRENT VALUE OF HOME		Please Select50,000 - 60,00060,000 - 70,00070,000 - 80,00080,000 - 90,00090,000 - 100,000100,000 - 110,000110,000 - 120,000120,000 - 130,000130,000 - 140,000140,000 - 150,000150,000 - 160,000160,000 - 170,000170,000 - 180,000180,000 - 190,000190,000 - 200,000200,000 - 225,000225,000 - 250,000250,000 - 275,000275,000 - 300,000300,000 - 325,000325,000 - 350,000350,000 - 375,000375,000 - 400,000400,000 - 425,000425,000 - 450,000450,000 - 475,000475,000 - 500,000500,000 - 550,000550,000 - 600,000600,000 - 650,000650,000 - 700,000700,000 - 750,000750,000 - 800,000800,000 - 850,000850,000 - 900,000900,000 - 950,000950,000 - 1000,0001,000,000 - 1,100,0001,100,000 - 1,200,0001,200,000 - 1,300,0001,300,000 - 1,400,0001,400,000 - 1,500,0001,500,000 - 1,600,0001,600,000 - 1,700,0001,700,000 - 1,800,0001,800,000 - 1,900,0001,900,000 - 2,000,0002,000,000 - 2,100,0002,100,000 - 2,200,0002,200,000 - 2,300,0002,300,000 - 2,400,0002,400,000 - 2,500,0002,500,000 - 2,600,0002,600,000 - 2,700,0002,700,000 - 2,800,0002,800,000 - 2,900,0002,900,000 - 3,000,0003,000,000 - 3,250,0003,250,000 - 3,500,0003,500,000 - 3,750,0003,750,000 - 4,000,0004,000,000 - 4,250,0004,250,000 - 4,500,0004,500,000 - 4,750,0004,750,000 - 5,000,000
ORIGINAL PURCHASE PRICE		Please Select50,000 - 60,00060,000 - 70,00070,000 - 80,00080,000 - 90,00090,000 - 100,000100,000 - 110,000110,000 - 120,000120,000 - 130,000130,000 - 140,000140,000 - 150,000150,000 - 160,000160,000 - 170,000170,000 - 180,000180,000 - 190,000190,000 - 200,000200,000 - 225,000225,000 - 250,000250,000 - 275,000275,000 - 300,000300,000 - 325,000325,000 - 350,000350,000 - 375,000375,000 - 400,000400,000 - 425,000425,000 - 450,000450,000 - 475,000475,000 - 500,000500,000 - 550,000550,000 - 600,000600,000 - 650,000650,000 - 700,000700,000 - 750,000750,000 - 800,000800,000 - 850,000850,000 - 900,000900,000 - 950,000950,000 - 1000,0001,000,000 - 1,100,0001,100,000 - 1,200,0001,200,000 - 1,300,0001,300,000 - 1,400,0001,400,000 - 1,500,0001,500,000 - 1,600,0001,600,000 - 1,700,0001,700,000 - 1,800,0001,800,000 - 1,900,0001,900,000 - 2,000,0002,000,000 - 2,100,0002,100,000 - 2,200,0002,200,000 - 2,300,0002,300,000 - 2,400,0002,400,000 - 2,500,0002,500,000 - 2,600,0002,600,000 - 2,700,0002,700,000 - 2,800,0002,800,000 - 2,900,0002,900,000 - 3,000,0003,000,000 - 3,250,0003,250,000 - 3,500,0003,500,000 - 3,750,0003,750,000 - 4,000,0004,000,000 - 4,250,0004,250,000 - 4,500,0004,500,000 - 4,750,0004,750,000 - 5,000,000
YEAR PURCHASED
FIRST MORTGAGE BALANCE		Please Select0 - 10,00010,000 - 20,00020,000 - 30,00030,000 - 40,00040,000 - 50,00050,000 - 60,00060,000 - 70,00070,000 - 80,00080,000 - 90,00090,000 - 100,000100,000 - 110,000110,000 - 120,000120,000 - 130,000130,000 - 140,000140,000 - 150,000150,000 - 160,000160,000 - 170,000170,000 - 180,000180,000 - 190,000190,000 - 200,000200,000 - 225,000225,000 - 250,000250,000 - 275,000275,000 - 300,000300,000 - 325,000325,000 - 350,000350,000 - 375,000375,000 - 400,000400,000 - 425,000425,000 - 450,000450,000 - 475,000475,000 - 500,000500,000 - 550,000550,000 - 600,000600,000 - 650,000650,000 - 700,000700,000 - 750,000750,000 - 800,000800,000 - 850,000850,000 - 900,000900,000 - 950,000950,000 - 1000,0001,000,000 - 1,100,0001,100,000 - 1,200,0001,200,000 - 1,300,0001,300,000 - 1,400,0001,400,000 - 1,500,0001,500,000 - 1,600,0001,600,000 - 1,700,0001,700,000 - 1,800,0001,800,000 - 1,900,0001,900,000 - 2,000,0002,000,000 - 2,100,0002,100,000 - 2,200,0002,200,000 - 2,300,0002,300,000 - 2,400,0002,400,000 - 2,500,0002,500,000 - 2,600,0002,600,000 - 2,700,0002,700,000 - 2,800,0002,800,000 - 2,900,0002,900,000 - 3,000,0003,000,000 - 3,250,0003,250,000 - 3,500,0003,500,000 - 3,750,0003,750,000 - 4,000,0004,000,000 - 4,250,0004,250,000 - 4,500,0004,500,000 - 4,750,0004,750,000 - 5,000,000
INTEREST RATE		(select rate) Less then 3% 3.25% 3.50% 3.75% 4.00% 4.25% 4.50% 4.75% 5.00% 5.25% 5.50% 5.75% 6.00% 6.25% 6.50% 6.75% 7.00% 7.25% 7.50% 7.75% 8.00% 8.25% 8.50% 8.75% 9.00% 9.25% 9.50% 9.75% 10.00% 10.25% 10.50% 10.75% 11.00% 11.25% 11.50% 11.75% 12.00% 12.25% 12.50% 12.75% 13.00% 13.25% 13.50% 13.75% 14.00% 14.25% 14.50% 14.75% 15.00% Greater the 15% (select type) Fixed Variable
SECOND MORTGAGE BALANCE		Please SelectNone0 - 10,00010,000 - 20,00020,000 - 30,00030,000 - 40,00040,000 - 50,00050,000 - 60,00060,000 - 70,00070,000 - 80,00080,000 - 90,00090,000 - 100,000100,000 - 110,000110,000 - 120,000120,000 - 130,000130,000 - 140,000140,000 - 150,000150,000 - 160,000160,000 - 170,000170,000 - 180,000180,000 - 190,000190,000 - 200,000200,000 - 225,000225,000 - 250,000250,000 - 275,000275,000 - 300,000300,000 - 325,000325,000 - 350,000350,000 - 375,000375,000 - 400,000400,000 - 425,000425,000 - 450,000450,000 - 475,000475,000 - 500,000500,000 - 550,000550,000 - 600,000600,000 - 650,000650,000 - 700,000700,000 - 750,000750,000 - 800,000800,000 - 850,000850,000 - 900,000900,000 - 950,000950,000 - 1000,0001,000,000 - 1,100,0001,100,000 - 1,200,0001,200,000 - 1,300,0001,300,000 - 1,400,0001,400,000 - 1,500,0001,500,000 - 1,600,0001,600,000 - 1,700,0001,700,000 - 1,800,0001,800,000 - 1,900,0001,900,000 - 2,000,0002,000,000 - 2,100,0002,100,000 - 2,200,0002,200,000 - 2,300,0002,300,000 - 2,400,0002,400,000 - 2,500,0002,500,000 - 2,600,0002,600,000 - 2,700,0002,700,000 - 2,800,0002,800,000 - 2,900,0002,900,000 - 3,000,0003,000,000 - 3,250,0003,250,000 - 3,500,0003,500,000 - 3,750,0003,750,000 - 4,000,0004,000,000 - 4,250,0004,250,000 - 4,500,0004,500,000 - 4,750,0004,750,000 - 5,000,000
INTEREST RATE		(select rate) Less then 3% 3.25% 3.50% 3.75% 4.00% 4.25% 4.50% 4.75% 5.00% 5.25% 5.50% 5.75% 6.00% 6.25% 6.50% 6.75% 7.00% 7.25% 7.50% 7.75% 8.00% 8.25% 8.50% 8.75% 9.00% 9.25% 9.50% 9.75% 10.00% 10.25% 10.50% 10.75% 11.00% 11.25% 11.50% 11.75% 12.00% 12.25% 12.50% 12.75% 13.00% 13.25% 13.50% 13.75% 14.00% 14.25% 14.50% 14.75% 15.00% Greater the 15% (select type) Fixed Variable
MONTHLY PAYMENTS
ARE YOU CURRENTLY BEHIND ON YOUR MORTGAGE?		(select one) yes no
NUMBER OF PAYMENTS BEHIND		0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
NUMBER OF TIMES LATE ON MORTGAGE		0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
THE LAST TIME YOU RE-FINANCED YOUR HOME		Please Select Under 6 Months 6-12 Months Over 12 Months Never
CREDIT AND EMPLOYMENT INFORMATION
HOW WOULD YOU RATE YOUR CREDIT		Excellent Good Fair Poor
PLACE OF EMPLOYMENT
YEARS THERE		(please select) under 1 year 1-3 years 3-5 years over 5 years
MONTHLY INCOME
MONTHLY DEBT (do not include mortgage/rent)
PLEASE FILL OUT IF THIS IS A PURHCASE TRANSACTION
Sales Price
Down Payment Amount
Source of Down Payment
Estimated Close of Escrow
COMMENTS
PLEASE ENTER INFORMATION THAT YOU FEEL IS IMPORTANT TO THE LENDERS.
Please send me future promotions by e-mail.