This Loan Will Be
Refinance
Purchase
* Denotes
Mandatory Fields
Borrower Information
*
Borrower's Name
Co-Borrower's Name
*
Current Address
* City
*
State
*
Zip
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
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
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Home Phone
*
Email Address
Email Address
*
How would you rate your credit
Excellent
Good
Fair
Major Credit
Issues
How would you rate their credit
Excellent
Good
Fair
Major Credit
Issues
Your Social Security Number
Their Social Security Number
Your Date Of Birth
Their Date Of Birth
Marital Status
Single
Marital Status
Single
Loan
Information
* What
State Is The Property In?
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
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
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
What
Type of Loan do you prefer
*
The property is my:
Primary Residence
Second Home
Investment
*
The type of
home is:
Single Family
Detached
2 - 4 Family
Townhouse
Condo
Co-op
Manufactured
Mobile
Other
Property
Information
Refinance
Mortgage
*
Desired Loan Amount
Whole
Numbers Only, No Commas,Periods, ect.
* Your
current mortgage balance:
Whole
Numbers Only, No Commas,Periods, ect.
*
Property Value
Whole
Numbers Only, No Commas, Periods, ect.
*
What Is Your
Interest Rate?
Whole
Numbers Only, No Commas,Periods, ect.
What
Is The Purpose Of The Refinance
Lower My Current Interest Rate
Pay off my home equity loan
Debt consolidation
Home Improvements
Receive Cash
Other
Choose One
What
Is Your Monthly Payment?
How
Soon Before You Refinance?
Immediately
Just Shopping
1 Month
2 Months
3 Months
4 Months
6 Months or More
Choose One
Does it include taxes and insurance?
Yes
No
Employment
Borrower Co-Borrower
*
Current Employer
Current Employer
*
Position
Position
* Years There
Years There
*
Work Phone
*
Monthly Income
*
Total Monthly Debt
* Assets
Work Phone
Monthly Income
Have
you ever had a bankruptcy?
Never Declared
Not yet discharged
Less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
Have
you ever had a Foreclosure?
Never Foreclosed
Less than 1 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
Currently
in foreclosure
*Referred
By:
Notice: Filling out this
form does not lock in rate
nor guarantee rate protection
of any kind. Loan
applications must be confirmed
verbally with a
representative. Please call us at the above number
to lock-in rate and/or to have us
answer any of your questions.
A loan officer
may contact you. A phone number is required.