*  Required Field  
           
          
         
        
           
          
         
        
           
          * First Name:  
           
           
           
          
         
        
           
           
           
           
           
          
         
        
           
           
           
          Last Name:  
           
           
          
         
        
           
           
           
           
          
         
        
           
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          * Email:  
           
          
         
        
           
           
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          Subject Property Address  
           
          
         
        
           
          
         
        
           
           
           
          
         
        
           
          Address:  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
           
           
          
         
        
           
          Address #2:  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
           
           
          
         
        
           
          City:  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
           
           
          
         
        
           
          * State:  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          * Property Type:  
           
          
         
        
           
          
         
        
           
           
           
          
         
        
           
           
           
           
          
         
        
           
           
          Single Family Residence (SFR)  
           
           
          2 -4 units  
           
          
         
        
           
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
           
           
          
         
        
           
           
           
           
          
         
        
           
           
          Townhome  
           
           
          
         
        
           
           
           
           
          Cooperative  
           
          
         
        
           
           
           
           
          
         
        
           
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
           
           
           
           
          
         
        
           
           
          Condo  
           
           
          Modular  
           
          
         
        
           
           
           
          
         
        
           
          
         
        
           
           
           
          
         
        
           
           
          Mobile/Manufactured Home  
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          What type of mortgage do you want (including FHA loans)?  
           
          
         
        
           
          
         
        
           
          
10 year 
15 Year 
20 Year 
25 Year 
30 Year 
40 Year 
 
 
           
          
         
        
           
           
          
1/1 Arm 
2/1 Arm 
3/1 Arm 
5/1 Arm 
7/1 Arm 
10/1 Arm 
 
 
           
          
         
        
           
          Fixed Rate:  
           
           
          Adjustable Rate:  
           
           
          
         
        
           
           
           
           
          
         
        
           
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          
Less than $80,000 
$80,000- $85,000 
$85,001- $90,000 
$90,001- $95,000 
$95,001- $100,000 
$100,001-$105,000 
$105,001-$110,000 
$110,001-$115,000 
$115,001-$120,000 
$120,001-$125,000 
$125,001- $130,000 
$130,001- $135,000 
$135,001-$140,000 
$140,001-$145,000 
$145,001-$150,000 
$150,001-$155,000 
$155,001-$160,000 
$165,001-$170,000 
$175,001-$180,000 
$180,001-$185,000 
$190,001-$195,000 
$195,001-$200,000 
$200,001-$205,000 
$205,001-$210,000 
$210,001-$215,000 
$215,001-$220,000 
$220,001-$225,000 
$225,001-$230,000 
$230,001-$235,000 
$235,001-$240,000 
$240,001-$245,000 
$245,001-$250,000 
$250,001-$255,000 
$255,001-$260,000 
$260,001-$265,000 
$265,001-$270,000 
$270,001-$275,000 
$275,001-$280,000 
$280,001-$285,000 
$285,001-$290,000 
$290,001-$295,000 
$295,001-$300,000 
$300,001-$305,000 
$305,001-$310,000 
$310,001-$315,000 
$315,001-$350,000 
$320,001-$325,000 
$325,001-$330,000 
$330,001-$335,000 
$335,001-$340,000 
$340,001-$345,000 
$345,001-$350,000 
$350,001-$355,000 
$355,001-$360,000 
$360,001-$365,000 
$365,001-$370,000 
$370,001-$375,000 
$375,001-$380,000 
$380,001-$385,000 
$385,001-$390,000 
$390,001-$395,000 
$395,001-$400,000 
$400,001-$410,000 
$410,001-$420,000 
$420,001-$430,000 
$430,001-$440,000 
$440,001-$450,000 
$450,001-$460,000 
$460,001-$470,000 
$470,001-$480,000 
$480,001-$490,000 
$490,001-$500,000 
$500,001-$510,000 
$510,001-$520,000 
$530,000-$540,000 
$540,001-$550,000 
$550,001-$560,000 
$560,001-$570,000 
$570,001-$580,000 
$580,001-$590,000 
$590,001-$600,000 
$600,001-$610,000 
$610,001-$620,000 
$620,001-$630,000 
$630,001-$640,000 
$640,001-$650,000 
$650,001-$660,000 
$660,001-$670,000 
$670,001-$680,000 
$680,001-$690,000 
$690,001-$700,000 
$700,001-$710,000 
$710,001-$720,000 
$720,001-$730,000 
$730,001-$740,000 
$740,001-$750,000 
$750,001-$760,000 
$760,001-$770,000 
$770,001-$780,000 
$780,001-$790,000 
$790,001-$800,000 
$800,001-$810,000 
$810,001-$820,000 
$820,001-$830,000 
$830,001-$890,000 
$890,001-$900,000 
$900,001-$910,000 
$910,001-$920,000 
$920,001-$930,000 
$930,001-$940,000 
$940,001-$950,000 
$950,001-$960,000 
$960,001-$970,000 
$970,001-$980,000 
$980,001-$990,000 
$990,001-$1,000,000 
$1,000,001-$2,000,000 
$2,000,001-$3,000,000 
$3,000,001-$4,000,000 
$4,000,001-$5,000,000 
$5,000,001-$6,000,000 
$6,000,001-$7,000,000 
$7,000,001-$8,000,000 
$8,000,001-$9,000,000 
$9,000,001-$10,000,000 
over $10,000,000 
 
 
           
          
         
        
           
          * What is your current property value?  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          
Less than $80,000 
$80,000- $85,000 
$85,001- $90,000 
$90,001- $95,000 
$95,001- $100,000 
$100,001-$105,000 
$105,001-$110,000 
$110,001-$115,000 
$115,001-$120,000 
$120,001-$125,000 
$125,001- $130,000 
$130,001- $135,000 
$135,001-$140,000 
$140,001-$145,000 
$145,001-$150,000 
$150,001-$155,000 
$155,001-$160,000 
$165,001-$170,000 
$175,001-$180,000 
$180,001-$185,000 
$190,001-$195,000 
$195,001-$200,000 
$200,001-$205,000 
$205,001-$210,000 
$210,001-$215,000 
$215,001-$220,000 
$220,001-$225,000 
$225,001-$230,000 
$230,001-$235,000 
$235,001-$240,000 
$240,001-$245,000 
$245,001-$250,000 
$250,001-$255,000 
$255,001-$260,000 
$260,001-$265,000 
$265,001-$270,000 
$270,001-$275,000 
$275,001-$280,000 
$280,001-$285,000 
$285,001-$290,000 
$290,001-$295,000 
$295,001-$300,000 
$300,001-$305,000 
$305,001-$310,000 
$310,001-$315,000 
$315,001-$350,000 
$320,001-$325,000 
$325,001-$330,000 
$330,001-$335,000 
$335,001-$340,000 
$340,001-$345,000 
$345,001-$350,000 
$350,001-$355,000 
$355,001-$360,000 
$360,001-$365,000 
$365,001-$370,000 
$370,001-$375,000 
$375,001-$380,000 
$380,001-$385,000 
$385,001-$390,000 
$390,001-$395,000 
$395,001-$400,000 
$400,001-$410,000 
$410,001-$420,000 
$420,001-$430,000 
$430,001-$440,000 
$440,001-$450,000 
$450,001-$460,000 
$460,001-$470,000 
$470,001-$480,000 
$480,001-$490,000 
$490,001-$500,000 
$500,001-$510,000 
$510,001-$520,000 
$530,000-$540,000 
$540,001-$550,000 
$550,001-$560,000 
$560,001-$570,000 
$570,001-$580,000 
$580,001-$590,000 
$590,001-$600,000 
$600,001-$610,000 
$610,001-$620,000 
$620,001-$630,000 
$630,001-$640,000 
$640,001-$650,000 
$650,001-$660,000 
$660,001-$670,000 
$670,001-$680,000 
$680,001-$690,000 
$690,001-$700,000 
$700,001-$710,000 
$710,001-$720,000 
$720,001-$730,000 
$730,001-$740,000 
$740,001-$750,000 
$750,001-$760,000 
$760,001-$770,000 
$770,001-$780,000 
$780,001-$790,000 
$790,001-$800,000 
$800,001-$810,000 
$810,001-$820,000 
$820,001-$830,000 
$830,001-$890,000 
$890,001-$900,000 
$900,001-$910,000 
$910,001-$920,000 
$920,001-$930,000 
$930,001-$940,000 
$940,001-$950,000 
$950,001-$960,000 
$960,001-$970,000 
$970,001-$980,000 
$980,001-$990,000 
$990,001-$1,000,000 
$1,000,001-$2,000,000 
$2,000,001-$3,000,000 
$3,000,001-$4,000,000 
$4,000,001-$5,000,000 
$5,000,001-$6,000,000 
$6,000,001-$7,000,000 
$7,000,001-$8,000,000 
$8,000,001-$9,000,000 
$9,000,001-$10,000,000 
over $10,000,000 
 
 
           
          
         
        
           
          * How much additional cash do you want to borrow?  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          
         
        
           
          
         
        
           
          Tell us about your Property  
           
          
         
        
           
          
         
        
           
          
Primary Residence 
Investment Property 
Second Home 
 
 
           
          
         
        
           
          * How do you use this property?  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          
         
        
           
          
         
        
           
          Tell Us About Your Finances  
           
          
         
        
           
          
         
        
           
          
Excellent 
Good 
Fair 
Poor 
 
 
           
          
         
        
           
          * How would you describe your credit history?  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
           
           
           
           
          
         
        
           
          *Do you have any recent foreclosures in the past 4  years?  
           
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          Yes  
           
          
         
        
           
           
          No  
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          
No Co-Borrower 
Spouse 
Other Co-Borrower 
 
 
           
          
         
        
           
          *Are you requesting a loan with a spouse or  another co-borrower?  
           
           
          
         
        
           
           
          
         
        
           
          
         
        
           
          Comments: