Contact Information

Name:
Home Phone:
Work Phone:
Fax: 
E-mail:

Loan Request

Purchase
Refinance
Home Improvement
Other, please describe:

Loan Amount

Loan amount desired is $

What state are you planning to purchase, refinance or mortgage in?

Type of Loan

Fixed Rate Mortgage
Adjustable Rate Mortgage
Two-Step / Balloon Mortgage
Haven't decided
Other, please state:

Personal Information

Annual household income is $
Monthly debt (Credit Cards, Loans, Leases, etc.) is $
Rate your credit history (A=excellent)
A
B
C
D

Please fill out :

• the purchase section only if buying a home.
• the refinance section only if refinancing.

When finished click on the send button.

PURCHASE SECTION

FILL THIS OUT IF PURCHASING A HOME

Please skip to the next section if refinancing

TimeFrame

Thinking about it
Actively Looking
About to make an offer
Have a sales contract

Realtor Information

I am working with a Realtor
Please refer me to a Realtor
I am buying directly from the seller
I am buying directly from the builder

Purchase Price

I expect to buy a home between $ and $

Down Payment

I expect to put between % and % down

REFINANCE SECTION

FILL THIS OUT ONLY IF REFINANCING

Please skip to the next section if applying for a second mortgage

Property Value

The property should appraise for $
Year Purchased
Purchase Price $

Existing loans / liens / judgements on property

1st loan balance $
2nd loan balance $
3rd loan balance $

Reason for Refinancing

Reduce Interest rates
Change from fixed to adjustable
Change from adjustable to fixed
Need cash out. Cash out required $
Other, please specify:

Current loan type

Fixed
Adjustable
Other, please specify: