1. Please choose the type of home loan you are shopping for below:

Loan program:

Property state

Property use

Property type

Property value
Applicant's First Name *
Co- Applicants First Name
Applicant's Last Name *
Co- Applicants Last Name
Current Street Address *
City *

State *
Zip Code *
Home Phone #
Best time to contact you?
Work Phone #
Mobile Phone / Pager #
Email Address *

2. Property Details

Do you currently Own or Rent ? Own Rent *

Property Type

Purchase Price of Your Home
* Example: 365000

Date Property was Acquired
Example: 9/2004

Present Value of Property $
* (Approximate Appraised Value) Example: 365000

3. Existing First Mortgage Details

If you do not have a 1st Mortgage, simply type 0 in the amount owe field
then move to question # 5.

Amount Owed on 1st $
* Example:125000

Interest Rate on 1st %
* Example:6.25
Rate Type Fixed Adjustable

Monthly Payments on 1st $
* Example:2248

4. Existing Second Mortgage Details
If you do not have a 2nd Mortgage, simply move to question # 5 .

Amount Owed on 2nd $

Interest Rate on 2nd %
Rate Type Fixed Adjustable

Monthly Payment $

5. Approximate Loan Amount Needed

Loan Amount Desired $
* Example: 120000

6. Your Credit Rating:

How would you rate your credit?
Excellent Good Fair Poor *

7. Additional Comments:

Please type in below anything you feel might be helpful
to us in consideration of your application: