Your
Full Name |
* |
Address |
* |
City |
* |
State(USA
Only) |
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
* UNITED STATES ONLY! |
Zip/Postal
Code |
* |
Home
Phone |
* |
Work
Phone |
* |
Email
Address |
* |
Best
Time To Call |
Morning at Home
Morning at Work
Afternoon at Home
Afternoon at Work
Evening at Home
Late Evening at Home
* |
Do
You Own Your Home? |
Yes
No
* Mobile Homes Do Not
Qualify |
Property
Value |
* Please use numbers only |
Property
Type |
Single
Family Residence
Condo
Townhouse
2-4 Plex
Other
* |
Purchase
Price |
* Please
use numbers only |
Year Acquired
|
* |
1st
Mortgage-Balance Owed |
* Please use numbers only
(ex:45000) enter 0 for none |
1st
Mortgage-Interest Rate |
Select
Below 7.0
7.1 - 7.49
7.5 - 7.99
8.0 - 8.49
8.5 - 8.99
9.0 - 9.49
9.5 - 9.99
10 or above
None
% |
Is
1st Adjustable or Fixed? |
Fixed
Adjustable
* |
Employer |
* |
Monthly
Gross Household Income |
* Please use numbers only |
2nd
Mortgage Balance owed |
>
* Please use numbers
only(ex:45000) enter 0 for none |
Amount
You Wish To Borrow |
Select
15,000 - 30,000
30,000 - 45,000
45,000 - 60,000
60,000 - 75,000
75,000 - 90,000
90,000 - 110,000
110,000 - 125,000
125,000 & Up
* |
Credit
Rating |
Select
Excellent
Good
Fair
Poor
* |
Monthly
Debt |
* Please use numbers only |
Loan
Interested In |
Select
Refinance Only
Refinance with Cash Out
Home Improvement
Debt Consolidation
Home Equity
*
|
Fast & Easy
-You Are Done !
|