*Required
Fields **Numbers
Only |
Name: |
* * |
Address: |
* * |
City: |
* * |
State (USA Only): |
AK
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
* * |
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: |
Must enter in
000's (ex. 45000)* |
Property Type: |
Single Family Residence
Condo
Townhouse
2-4 Plex
Other
|
Purchase Price: |
|
Year Acquired: |
* * |
1st Mortgage Balance Owed: |
**Enter in 000's
(ex.45000) - Enter 0 if none |
1st Mortgage Interest Rate: |
10% or above 9.0
- 9.49 9.5 - 9.99 8.5
- 8.99 8.0 - 8.49 7.1 -
7.49 7.5 - 7.99 Below
7.0 None * |
Is 1st Adjustable or Fixed?: |
Fixed
Adjustable
* |
2nd Mortgage Balance Owed: |
**Enter in 000's
(ex.45000) - Enter 0 if none* |
Amount You Wish To Borrow: |
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
|
Employer: |
* |
Monthly Gross Household Income: |
** |
Monthly Debt: |
* |
Credit Rating: |
Good
Fair
Poor
* |
Loan Interested In: |
Debt Consolidation
Second Mortgage
Home Improvement
Refinance
Purchase
* |
|
|