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Applicant
Information
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| * First Name: |
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| * Last Name: |
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| * Daytime Telephone
Number: |
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| Alternate Telephone
Number: |
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| Best Time To Call: |
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| * Email Address: |
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| * Rate your credit: |
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| Are you self employed? |
Yes No |
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| * Approximate monthly
income: |
$ | |
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Is there a co-applicant on
the current loan? |
Yes No |
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| Co-Applicant
Information |
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| First Name: |
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| Last Name: |
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| Co-applicant
credit: |
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Approximate
monthly co-applicant
income: |
$ | |
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| Is the co-applicant self
employed? |
Yes No |
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| Property
Information |
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| * Property Type: |
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| * Street: |
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| * City: |
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| * Zip: |
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| * State: |
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| * Estimated Property
Value: |
$ | |
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| Owner occupied: |
Yes No |
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| Loan
Information |
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| * 1st Mortgage Lender |
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| * 1st Mortgage Loan Type: |
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| * 1st Mortgage
Balance: |
$ | |
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| * 1st Mortgage Interest
Rate: |
% |
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Does your payment include
taxes and insurance? |
Yes No |
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Do you have a
prepayment penalty? |
Yes NoNot Sure |
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| Do you have a 2nd loan? |
Yes No |
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| 2nd Mortgage Lender |
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| 2nd Mortgage Loan Type: |
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| 2nd Mortgage Interest
Rate: |
% |
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Do you have a
prepayment penalty on your 2nd
loan? |
Yes NoNot Sure |
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| Additional
Information |
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| Purpose for
refinancing: |
Reduce Rate Reduce
Payment Shorten Term Convert Adjustable to Fixed Cash out for consolidation Cash Out for Other Purposes |
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| Additional Comments: |
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