PERSONAL INFORMATION 
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* Your Name:
* Address:
* City:
* State:  Zip: 
*Home Phone:
*Work Phone:
* Fax:
* E-Mail:

Please contact me by Phone  Fax  Email

What is the best time to contact you?



 LOAN INFORMATION 
 

Do you want us to find you:
1 Lender  1-3 Lenders  More than 3 lenders

Is this new mortgage for a Purchase, Refinance or Home Equity Loan?
Purchase  Refinance  Home Equity

If you chose Refinancing or Home Equity above, what is your current home loan interest rate?
%

If you chose Refinancing or Home Equity above, what is your approximate current home loan balance?
(Combine 1st and 2nd Mortgage Balances, if applicable)

If you chose Refinancing or Home Equity above, are you planning on borrowing more than your current home loan balance?
YES NO

Please complete the following for Purchases, Refinances & Home Equity Loans:

What City, State or general area is the home being financed located in?
City: State: or General Area:

What is the approximate new home loan amount you are seeking?

What is the approximate appraised value (or purchase price) of the home you need a new home loan for?

If applicable, are you a first-time home buyer?
YES  NO

What type of home loan program are you most interested in?
30-year Fixed
20-year Fixed 
15-year Fixed
10-year Fixed		 1-year ARM
3-year ARM
5-year ARM
7-year ARM 		5-yearBalloon
7-year Balloon
Jumbo Fixed
Jumbo ARM		 FHA Fixed
FHA ARM
VA
Home Equity
Other:

Will you need to obtain this home loan within the next...
30 to 60 Days
60 to 90 days
within the next 6 months
If none of the above, then when?

Which of the following best describes your current credit situation?
Excellent   Good   Fair   Bruised
 


 ADDITIONAL INFORMATION 
 

Please list any additional comments below or special needs and requests?

Please tell us how you heard about us?

 

Thank you for taking the time to complete this form, lenders will be contacting you shortly with offers.