Loan Information

Loan Purpose:	I want to... Refinance Consolidate bills/Pay off debt Get cash out Make home improvements Home equity loan Unsecured Personal Loan
Loan Amount:	$.00 (minimum loan amount must be $40,000)

Property Information

What type of home do you own?

Primary - Family Home Primary - Townhouse Primary - Condo Primary - Mobile Home 2nd Home - Family Home 2nd Home - Townhouse 2nd Home - Condo 2nd Home - Mobile Home Investment - Family Home Investment - Townhouse Investment - Condo Investment - Mobile Home Rental

Address:

City:

State: SelectAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutD.C.DelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Zip:

How long have you owned this home? Duration of Ownership?<1 Year1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years20+ years

What is the estimated home value? Home Value? $50,000 to $55,000 $55,001 to $60,000 $60,001 to $65,000 $65,001 to $70,000 $70,001 to $75,000 $75,001 to $80,000 $80,001 to $85,000 $85,001 to $90,000 $90,001 to $95,000 $95,001 to $100,000 $100,001 to $105,000 $105,001 to $110,000 $110,001 to $115,000 $115,001 to $120,000 $120,001 to $125,000 $125,001 to $130,000 $130,001 to $135,000 $135,001 to $140,000 $140,001 to $145,000 $145,001 to $150,000 $150,001 to $155,000 $155,001 to $160,000 $160,001 to $165,000 $165,001 to $170,000 $170,001 to $175,000 $175,001 to $180,000 $180,001 to $185,000 $185,001 to $190,000 $190,001 to $195,000 $195,001 to $200,000 $200,001 to $210,000 $210,001 to $220,000 $220,001 to $230,000 $230,001 to $240,000 $240,001 to $250,000 $250,001 to $260,000 $260,001 to $270,000 $270,001 to $280,000 $280,001 to $290,000 $290,001 to $300,000 $300,001 to $310,000 $310,001 to $320,000 $320,001 to $330,000 $330,001 to $340,000 $340,001 to $350,000 $350,001 to $360,000 $360,001 to $370,000 $370,001 to $380,000 $380,001 to $390,000 $390,001 to $400,000 $400,001 to $420,000 $420,001 to $440,000 $440,001 to $460,000 $460,001 to $480,000 $480,001 to $500,000 $500,001 to $525,000 $525,001 to $550,000 $550,001 to $575,000 $575,001 to $600,000 $600,001 to $625,000 $625,001 to $650,000 $650,001 to $675,000 $675,001 to $700,000 $700,001 to $725,000 $725,001 to $750,000 $750,001 to $775,000 $775,001 to $800,000 $800,001 to $825,000 $825,001 to $850,000 $850,001 to $875,000 $875,001 to $900,000 $900,001 to $925,000 $925,001 to $950,000 $950,001 to $975,000 $975,001 to $1,000,000 Over $1,000,000

Do you currently have a first mortgage on this home? Yes No First mortgage payment amount? First mortgage payment $1 to $250 $251 to $500 $501 to $750 $751 to $1,000 $1,000 to $1,500 $1,501 to $2,000 $2,001 to $2,500 $2,501 to $3,000 $3,001 to $3,500 $3,501 to $4,000 Over $4,000 First mortgage balance? Please select $0 (no first mortgage) $1 to $5,000 $5,001 to $10,000 $10,001 to $15,000 $15,001 to $20,000 $20,001 to $25,000 $25,001 to $30,000 $30,001 to $35,000 $35,001 to $40,000 $40,001 to $45,000 $45,001 to $50,000 $50,001 to $55,000 $55,001 to $60,000 $60,001 to $65,000 $65,001 to $70,000 $70,001 to $75,000 $75,001 to $80,000 $80,001 to $85,000 $85,001 to $90,000 $90,001 to $95,000 $95,001 to $100,000 $100,001 to $105,000 $105,001 to $110,000 $110,001 to $115,000 $115,001 to $120,000 $120,001 to $125,000 $125,001 to $130,000 $130,001 to $135,000 $135,001 to $140,000 $140,001 to $145,000 $145,001 to $150,000 $150,001 to $155,000 $155,001 to $160,000 $160,001 to $165,000 $165,001 to $170,000 $170,001 to $175,000 $175,001 to $180,000 $180,001 to $185,000 $185,001 to $190,000 $190,001 to $195,000 $195,001 to $200,000 $200,001 to $210,000 $210,001 to $220,000 $220,001 to $230,000 $230,001 to $240,000 $240,001 to $250,000 $250,001 to $260,000 $260,001 to $270,000 $270,001 to $280,000 $280,001 to $290,000 $290,001 to $300,000 $300,001 to $310,000 $310,001 to $320,000 $320,001 to $330,000 $330,001 to $340,000 $340,001 to $350,000 $350,001 to $360,000 $360,001 to $370,000 $370,001 to $380,000 $380,001 to $390,000 $390,001 to $400,000 $400,001 to $420,000 $420,001 to $440,000 $440,001 to $460,000 $460,001 to $480,000 $480,001 to $500,000 $500,001 to $520,000 $520,001 to $540,000 $540,001 to $560,000 $560,001 to $580,000 $580,001 to $600,000 $600,001 to $620,000 $620,001 to $640,000 $640,001 to $660,000 $660,001 to $680,000 $680,001 to $700,000 $700,001 to $720,000 $720,001 to $740,000 $740,001 to $760,000 $760,001 to $780,000 $780,001 to $800,000 $800,001 to $820,000 $820,001 to $840,000 $840,001 to $860,000 $860,001 to $880,000 $880,001 to $900,000 $900,001 to $920,000 $920,001 to $940,000 $940,001 to $960,000 $960,001 to $980,000 $980,001 to $1,000,000 Over $1,000,000 Current mortgage interest rate? 0123456789101112131415161718 . 0005101520253035404550556065707580859095% Fixed or variable? Fixed Variable

Do you currently have a 2nd mortgage on this home? Yes No Second mortgage payment amount?  Second mortgage payment $1 to $250 $251 to $500 $501 to $750 $751 to $1,000 $1,000 to $1,500 $1,501 to $2,000 $2,001 to $2,500 $2,501 to $3,000 $3,001 to $3,500 $3,501 to $4,000 Over $4,000 Second mortgage balance? Please select $0 (no second mortgage) $1 to $5,000 $5,001 to $10,000 $10,001 to $15,000 $15,001 to $20,000 $20,001 to $25,000 $25,001 to $30,000 $30,001 to $35,000 $35,001 to $40,000 $40,001 to $45,000 $45,001 to $50,000 $50,001 to $55,000 $55,001 to $60,000 $60,001 to $65,000 $65,001 to $70,000 $70,001 to $75,000 $75,001 to $80,000 $80,001 to $85,000 $85,001 to $90,000 $90,001 to $95,000 $95,001 to $100,000 $100,001 to $105,000 $105,001 to $110,000 $110,001 to $115,000 $115,001 to $120,000 $120,001 to $125,000 $125,001 to $130,000 $130,001 to $135,000 $135,001 to $140,000 $140,001 to $145,000 $145,001 to $150,000 $150,001 to $155,000 $155,001 to $160,000 $160,001 to $165,000 $165,001 to $170,000 $170,001 to $175,000 $175,001 to $180,000 $180,001 to $185,000 $185,001 to $190,000 $190,001 to $195,000 $195,001 to $200,000 $200,001 to $210,000 $210,001 to $220,000 $220,001 to $230,000 $230,001 to $240,000 $240,001 to $250,000 $250,001 to $260,000 $260,001 to $270,000 $270,001 to $280,000 $280,001 to $290,000 $290,001 to $300,000 $300,001 to $310,000 $310,001 to $320,000 $320,001 to $330,000 $330,001 to $340,000 $340,001 to $350,000 $350,001 to $360,000 $360,001 to $370,000 $370,001 to $380,000 $380,001 to $390,000 $390,001 to $400,000 $400,001 to $420,000 $420,001 to $440,000 $440,001 to $460,000 $460,001 to $480,000 $480,001 to $500,000 $500,001 to $520,000 $520,001 to $540,000 $540,001 to $560,000 $560,001 to $580,000 $580,001 to $600,000 $600,001 to $620,000 $620,001 to $640,000 $640,001 to $660,000 $660,001 to $680,000 $680,001 to $700,000 $700,001 to $720,000 $720,001 to $740,000 $740,001 to $760,000 $760,001 to $780,000 $780,001 to $800,000 $800,001 to $820,000 $820,001 to $840,000 $840,001 to $860,000 $860,001 to $880,000 $880,001 to $900,000 $900,001 to $920,000 $920,001 to $940,000 $940,001 to $960,000 $960,001 to $980,000 $980,001 to $1,000,000 Over $1,000,000

Your Information

First Name:	Last Name:

Home Phone Number:		Work Phone Number: [optional]
() -		() - Ext.

Email Address:

Email Address: [verify]

Primary borrower's employment status Select employment status Employed Self-employed Retired Disabled Not employed

Gross annual household income Select annual income Less than $20,000 $20,000 to $25,000 $25,001 to $30,000 $30,001 to $35,000 $35,001 to $40,000 $40,001 to $45,000 $45,001 to $50,000 $50,001 to $55,000 $55,001 to $60,000 $60,001 to $70,000 $70,001 to $80,000 $80,001 to $90,000 $90,001 to $100,000 $100,001 to $110,000 $110,001 to $120,000 $120,001 to $130,000 $130,001 to $140,000 $140,001 to $150,000 $150,001 to $160,000 $160,001 to $170,000 $170,001 to $180,000 $180,001 to $190,000 $190,001 to $200,000 Over $200,000

Are you applying with a coborrower? Yes No

Co-Borrower's Name First Name: Last Name: Co-borrower's employment status Select employment status Employed Self-employed Retired Disabled Not employed

Minimum monthly debt payment? Select amount $0 (no debt) $1 to $250 $251 to $500 $501 to $750 $751 to $1,000 $1,001 to $1,250 $1,251 to $1,500 $1,501 to $1,750 $1,751 to $2,000 $2,001 to $2,500 $2,501 to $3,000 $3,001 to $4,000 $4,001 to $5,000 $5,001 or more Auto loan, credit card, etc. (Alimony and mortgage payments should NOT be included here.)

Describe your credit Please select one Excellent – Pay bills on time, every time Good – Usually pay bills on time Fair – Often pay bills late Poor – Recent Bankruptcy/foreclosure

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