Borrower/Co-Borrower Information
Borrower's Full Name
Borrower's Employer Name
Property Address
(Use your
present address if still shopping for a home)
Monthly Income
Property City
State
(Names
listed are where we lend)
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Indiana
Idaho
Illinois
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
Years on Job
Please Select
< 1 Year
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 or More
Zip Code
Position or Title
Property County
Date of Birth(mm-dd-yyyy)
Home Phone
Anytime
8 am - 10 am
10 am - 12 pm
12 pm - 2 pm
2 pm - 4 pm
4 pm - 6 pm
6 pm - 8 pm
Co-Borrower's Name
(if applicable)
Either Phone
Work Phone
Home Phone
Co-Borrower's Social Security #
Borrower's Social Security #
Co-Borrower's Employer Name
E-Mail Address
Co-Borrower's Monthly Income
Rate Your Credit
Please Select
Excellent
Good
Fair
Poor
Co-Borrower's
Total Income
Monthly Credit Card Payments
Co-Borrower's Years on Job
Please Select
< 1 Year
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 or More
Date of Birth
(mm-dd-yyyy)
Property Information
Property Type
Please Select
Single Family
Town House
Condo (1-4 stories)
Condo (5+ stories)
Manufactured Home
Multi-Family (2-4 units)
Commercial
Other
Finance Request Type
Please Select
New Purchase
Straight Refinance
Refinance & Payoff Other Bills
Targeted or Purchase Price
Loan Type
Please Select
Conventional
FHA
VA
Jumbo
Rural
Estimated Value
Loan Amount
($50,000
and more only)
Second Mortgage Company
(if any)
Current Interest Rate
Please Select
Blank if Purchasing
3.00%
3.125%
3.25%
3.375%
3.50%
3.625%
3.75%
3.875%
4.00%
4.125%
4.25%
4.375%
4.50%
4.625%
4.75%
4.875%
5.00%
5.125%
5.25%
5.375%
5.50%
5.625%
5.75%
5.875%
6.00%
6.125%
6.25%
6.375%
6.50%
6.625%
6.75%
6.875%
7.00%
7.125%
7.25%
7.375%
7.50%
7.625%
7.75%
7.875%
8.00%
8.125%
8.25%
8.375%
8.50%
8.625%
8.75%
8.875%
9.00%
9.125%
9.25%
9.375%
9.50%
9.625%
9.75%
0.875%
10.00%
10.125%
10.25%
10.375%
10.50%
10.625%
10.75%
10.875%
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%
15.25%
15.50%
15.75%
16.00%
16.25%
16.50%
16.75%
17.00%
17.25%
17.50%
17.75%
18.00%
18.25%
18.50%
18.75%
19.00%
19.25%
19.50%
19.75%
20.00%
Second Mortgage Interest Rate
Please Select
None
5.00%
5.125%
5.25%
5.375%
5.50%
5.625%
5.75%
5.875%
6.00%
6.125%
6.25%
6.375%
6.50%
6.625%
6.75%
6.875%
7.00%
7.125%
7.25%
7.375%
7.50%
7.625%
7.75%
7.875%
8.00%
8.125%
8.25%
8.375%
8.50%
8.625%
8.75%
8.875%
9.00%
9.125%
9.25%
9.375%
9.50%
9.625%
9.75%
0.875%
10.00%
10.125%
10.25%
10.375%
10.50%
10.625%
10.75%
10.875%
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%
15.25%
15.50%
15.75%
16.00%
16.25%
16.50%
16.75%
17.00%
17.25%
17.50%
17.75%
18.00%
18.25%
18.50%
18.75%
19.00%
19.25%
19.50%
19.75%
20.00%
Approximate Loan Balance
Monthly Payment
Second Mortgage Monthly Payment
Taxes & Ins. Included?
How did you find us?
Please Select
Google
Yahoo
MSN
AOL
Other Search Engine
Mortgage Professor
Friend
TV Commercial
Radio Commercial
Newspaper Ad
Other
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