Are you a home
owner?
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Choose
one... Yes
No |
Primary Applicant
Name: |
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Co-Applicant Name: |
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Street Address: |
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City: |
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State: |
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Zip Code: |
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Home Phone: |
Example: (334) 123-4567 |
Work Phone: |
Example: (342) 567-8901 |
Property Type: |
Select your property...
Single
Family Residence Condominium Townhouse |
Original Purchase
Price: |
Example: 100K |
Year Acquired: |
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Estimated Property
Value: (Must be at least $50K) |
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Amount Owed on 1st
Mortgage: |
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Current Interest Rate on
1st Mortgage: |
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Fixed Or
Adjustable? |
Choose
one... Fixed Adjustable |
Monthly Payment on 1st
Mortgage: |
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Amount Owed on 2nd
Mortgage: |
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Current Interest Rate on
2nd Mortgage: |
|
Fixed or
Adjustable? |
Choose
one... Fixed Adjustable |
Monthly Payment on 2nd
Mortgage: |
|
Current Employer: |
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Years With Current
Employer: |
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Gross Yearly
Income: |
Example: 60K |
How is your credit? |
Make
your best guess... Excellent Good Fair Poor |
Best Time To Contact
You: |
Choose
one... Morning at Work
Afternoon at
Work Evening at Work
Morning at
Home Afternoon at
Home Evening at
Home |
Type Of Loan
Desired: |
Select a
loan... Second Mortgage
Debt
Consolidation Refinance Refinance with
Cash Out Home Equity
Line of Credit |
Loan Amount
Desired: (Must be at least $30K) |
Example: 80K |
Your E-Mail
Address: |
Must be in form: name@domain.com. Please
verify. Thanks! |
|
|
Please verify your information - especially
your telephone numbers and e-mail address - before
pressing the button. |
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