Type of request Purchase Refinance              Property Type Single family home 2-4 family home Condo Modular Manufactured Commercial Townhome

   Property use Primary residence Second home Investment property       Credit Grade Excellent Good Fair Bad  

  How long will you own this home?  est. time 0-2 yrs. 3-5 yrs. 5-10 yrs. forever

  Loan amount     Home Value  

  Monthly income:            Income type Hourly/Salary Self Employed

  If Applicable:

  1st mortgage balance   Rate  

  2nd mortgage balance  Rate  

  Do you have an adjustable rate?   choose one No Yes Don't know

  If refinance:   Most important Lower payments lower interest rate Convert to fixed rate Bill consolidation Shorten term Take cash out

  Property Located in which State:             

 Contact information:

  First name:        

  Last name:       

  Home phone:     

  Work phone:      

  E-mail: