General Information (Please fill out for all types of loans. Be sure to include a name and phone #)

Name:

Home Phone: Work Phone:

E-mail: Fax:

Best time to call:

Property Location - City: State:

Loan Request:  Click on arrow to select.. Purchase Refinance Credit Line Home Improvement Traveling Notary Service Loan Document Signing Other, please describe Owner Occupied Non owner occupied

If "other"... (Please type in here)

Loan Amount Desired: $   Loan Type: Click on arrow to select... 30 year fixed 15 year fixed 30/5 year fixed 30/7 year fixed Haven't decided Other, please describe

Annual Household Income: $

Credit History Click on arrow to select... Excellent Good, some late pays Some credit problems Major credit problems Don't know

Purchase Section (Please fill out if you're purchasing property)

Status: Click on arrow to select... Thinking about it. Actively looking Ready to make an offer Property in escrow Other, describe

If "other"... (Please type in here)

Purchase Price Range:   Between  $ and $

Down Payment Range:   Between $ and $

or Down Payment Percent: Between % and %

Refinance Section (Please fill out if you're refinancing property)

Property Value: Property Should Appraise for $

Existing Loans on Property:   1st Loan Balance $

2nd Loan Balance $ 3rd Loan Balance $

Reason for Refinancing: Click on arrow to select... Reduce Interest Rates Change from fixed to adjustable Change from Adjustable to Fixed Need Cash out Reduce Payments Other, please describe

If "other"... (Please type in here)

Current Loan Type:  Click on arrow to select... Fixed Rate Adjustable Rate Other, please specify

If "other"... (Please type in here)

Second Mortgage Section (Please fill out for 2nd Mortgages, Credit Lines, or Home Improvement Loans)

Type of Loan:  Click on arrow to select... Credit Line Fixed 2nd mortgage Credit Line Title 1 Home Improvement Other, please describe

If "other"... (Please type in here) 

Existing Loans on the property:

1st Loan Balance $

2nd Loan Balance $

Reason for Loan Click on arrow to select.. Home Improvement Pay off bills Other, please specify

If "other"...(Please type in here)

General Comments

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