PURCHASE - Mortgage Info.
Purchase Price or Price Range:
Monthly Payment Range (approx.):
Down Payment Range:
REFINANCE - 2nd's & Home Improvement
Home Value (approx.):
Mortgage(s) Balance:
Loan Amount Desired:
How long have you owned your home?
Income Information
Borrower Gross Income (monthly):
Co-Borrower Gross Income (monthly):
Additional Income:
Monthly Bills
Car Payment(s):
Credit Card(s) min. Monthly Payment(s):
Other Loans Monthly Payment(s):
Credit Rating:	Choose Perfect Very Good Average Rough No Credit Don't Know
Personal Information
Borrower Name:
Borrower SSN#
May we check your credit report	Yes: No:
Co-Borrower Name:
Address:
City:
State:	Choose AL AK AZ AR CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY AE AA AP
Zip Code:
Phone (day):	() Ext.
Phone (night):	() Ext.
E-mail Address:
Please leave any comments or instructions in the comments box.