Application Note: Fields marked with an asterisk (*) are required fields. Your Contact Information * First Name:     * Last Name:     * Street Address:     * City:     * State:     * Zip Code:      * E-mail Address:      * Home Phone:     Ext:     Work Phone:     Ext:     Fax Number:       Best time to contact you:       Quick Loan Application Type of Loan you need:   -----Select One ----- Refinance Home Equity Purchase Debt Consolidation       Tell Us About Your Property Where is the property located:   -----Select One ----- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Mississippi Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Property Zip Code:      Property Type:   ----- Select One ------ Single Family Condominium Town Home Multi family Property Use:   -----Select One ----- Primary Residence Investment Secondary Residence       Tell Us About Your Loan Estimate property value:   -----Select One ----- $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $210,000 $220,000 $230,000 $240,000 $250,000 $260,000 $270,000 $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 $340,000 $350,000 $360,000 $370,000 $380,000 $390,000 $400,000 $420,000 $440,000 $460,000 $480,000 $500,000 $520,000 $540,000 $560,000 $580,000 $600,000 $620,000 $640,000 $660,000 $680,000 $700,000 $720,000 $740,000 $760,000 $780,000 $800,000 $820,000 $840,000 $860,000 $880,000 $900,000 $920,000 $940,000 $960,000 $980,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,750,000 $2,000,000+ Estimate loan amount:   -----Select One ----- 90000 100000 110000 120000 130000 140000 150000 160000 170000 180000 190000 200000 210000 220000 230000 240000 250000 260000 270000 280000 290000 300000 310000 320000 330000 340000 350000 360000 370000 380000 390000 400000 420000 440000 460000 480000 500000 520000 540000 560000 580000 600000 620000 640000 660000 680000 700000 720000 740000 760000 780000 800000 820000 840000 860000 880000 900000 920000 940000 960000 980000 1000000 1100000 1200000 1300000 1400000 1500000 1750000 2000000       Tell Us About Your Personal Finances Credit Status:   -------Select One ------- Excellent Good, Pay My Bills On Time Fair, Make/Made Some Late Payments Poor, Late On All Payments Annual Income:   -----Select One ----- $0 - $10,000 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,999 $100,000 - $124,999 $125,000 - $149,999 $150,000+   Occupational Status:   Employed Self Employed Retired Not Employed Have you ever declared backruptcy?   No/Not in Past 7 Years 5 - 7 Years Ago 2 - 5 Years Ago 1 - 2 Years Ago Less Than 12 Months Ago   Monthly debt payments   -----Select One ----- $0 $1 - $199 $200 - $399 $400 - $599 $600 - $799 $800 - $999 $1,000+         Submit this form for a low cost and hassle free mortgage. Our Local Lenders will contact you within 24 hours offering mortgage quotes at the lowest possible rates, tailored to meet your requirements. Your information will be treated with utmost confidentiality.   ATTENTION!!! The interest rates provided are subject to change without any notice. APR stands for Annual Percentage Rate. NOT EVERY APPLICANT IS ENTITLED FOR A REAL ESTATE FINANCING. IF YOU APPLY FOR A REAL ESTATE LOAN/MORTGAGE, YOU AND YOUR COLLATERAL REAL PROPERTY MUST QUALIFY FOR IT. Your personal qualifications depend on your credit history, income/employment and assets. Your property will be subject to appraisal and title search. If you need advice in accounting and/or legal matter, please consult your accountant and/or legal advisor.

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