What type of loan are you looking for?                                            
New Home Purchase Refinance Better Rate Only Refinance Cash Out / Home Equity Loan Refinance / Debt Consolidation Commercial Purchase Commercial Refinance Construction Construction Permanent Home Equity Line of Credit (HELOC) 2nd Mortgage Bankruptcy Chapter 13 Buyout Foreclosure Bailout Not Sure Other                            Other/Comment:  
< (Check Here is you would like to know more about Interest Only)

How long do you plan on keeping this loan before you either sell the property OR refinance this loan once?   
< 6 Months 6 Months to 1 Year 1 Year to 3 Years 3 Years to 5 Years 5 Years to 7 Years 7 Years - 10 Years 10 Years - 15 Years 15 Years - 20 Years 20 Years - 25 Years 25 Years - 30 Years Not Sure                                                           Other/Comment:  

What type of loan would you like us to research for you?
Fixed Rate Option ARM (Adjustable Rate Mortgage) Balloon Payment I'd like to keep my options open. Not Sure                            Other/Comment:  

If Purchase, What is the Sale Price?
If Refinance, What is your Current Loan Amount? 
< $25,000 $25,000- $49,999 $50,000- $59,999 $60K - $74,999 $75K - $99,999 $100,000- $359,650 $359,651- $400,000 $400,001 - $650,000 $650,001 - $1,000,000 $1,000,001 - $1,500,000 $1,500,001 - $2,000,000 $2,000,001 - $5,000,000 > $5,000,000 Not Sure                                                     Other/Comment: $

If Purchase, What Loan Amount be after Down Payment?
If Refinance, What will the New Loan Amount be?

< $25,000 $25,000- $49,999 $50,000- $59,999 $60K - $74,999 $75K - $99,999 $100,000- $359,650 $359,651- $400,000 $400,001 - $650,000 $650,001 - $1,000,000 $1,000,001 - $1,500,000 $1,500,001 - $2,000,000 $2,000,001 - $5,000,000 > $5,000,000 Not Sure                                         Source of Down Payment Bridge Loan Cash on Hand Checking/Savings Deposit on Sales Contract Equity from Pending Sale Equity from Subject Property Equity on Sold Property Gift Funds Life Insurance Cash Value Lot Equity Other Type of Down Payment Rent with Option to Purchase Retirement Funds Sale of Chattel Secured Borrowed Funds Stocks & Bonds Sweat Equity Trade Equity Trust Funds Unsecured Borrowed Funds  
                                                                             Amount of Down Payment: $

Loan Term  
30 Years 25 Years 20 Years 15 Years 10 Years Other Not Sure                                                                            Other/Comment: Years
    

Type of Work?                                                                                      
W2 Wage Earner Hourly / Salary / Tips 1099 Wage Earner / Contractor / Self Employed Fixed Income Pension Retirement Disability Social Security Prefer Not to provide this Information on this loan at all Other Not Sure Alimony/Child Support Income Automobile/Expense Account Income Foster Care Military Pay Notes Receivable/Installment Real Estate, Mortgage Differential Income Subject Property Net Cash Flow (2 - 4 unit owner occupied) Trust Income Unemployment/Welfare Income VA Benefits (Non-education) Other/Comment:

Income Verification Level you will be able to provide us with? 
Full Doc Programs Bank Statement Programs Stated Income Verified Assets Stated Income Stated Assets No Income No Asset Programs No Document Programs Not Sure                                           Other/Comment:

What type of Property will this loan be for?
Single Family Residence Condominium (Less than 4 Stories High) Condominium (4 stories or higher) Townhouse / PUD Duplex Properties Triplexes / Quadplex Properties Mobile Homes / Detached Properties Raw Land Farm / Rural Properties Commercial Other                              Other/Comment:

How will this property be vested?
Single Man Single Woman Joint Tenants / Joint Contractual To be determined in escrow Unmarried man Unmarried woman Tenants in common Community property Not Sure                                         Other/Comment:

What will your residency be in this property?
Primary Residence Owner Occupied Secondary Residence Owner Occupied Investment Property Non Owner Occupied Investment Property Owner Occupied Not Sure Other                           Other/Comment:

Would you like escrows? 
(Escrows are dividing your Real Estate Tax and Insurance Bills into 12 equal monthly payments and adding them into your monthly mortgage payment.  When your escrowed account's value increases, so will your monthly payment. If you choose not to have escrows, you will have to pay your Tax and Insurance Bills on your own when they're due. Check All that apply and write in their amounts. If you don't know the amounts, Best guess will do.)

Type                   Yes                    Amount
Taxes                                                                            $ (Real Estate Property Taxes Only)
Insurance                                                                     $ (Includes Hazard, Hurricane, Flood)
Home Owner Association Dues                              $ (HOA Fees/Dues cannot be escrowed)
*If this property has HOA dues/fees, are they:             Weekly Monthly Bi-Monthly Bi-Weekly Every 3 Months Every 4 Months Every 6 Months Annually Bi-Annually

First Name   Middle Name Last Name Jr. Sr. II III Other None
                                                                                                                                                                                      Suffix

Phone Number   Fax Number        

Email  

Present Address     
Property Address   
(Please include Street Address, City, State, Zip Code)
< (Check here if Property Address is the same as the Present Address ex. Refinance)   

*What is your middle credit score range (best guess will do) ?     
=< 499 500 - 549 550 - 579 580 - 599 600 - 619 620 - 639 640 - 659 660 - 679 680 - 699 700 - 719 => 720     (If you have 4 scores, choose your lowest middle score range)
(We will not ask for your Social Security Number or Date of Birth over the internet even with our secure server connection. However, providing this information will speed the process up and will provide more accurate quotes. When one of our Licensed Brokers calls you for a live response, we will go over this information with you.)

If employed, How many years at the same job? How many years in the same line of work?
< (Check here if you are self employed)   

What type of work do you do?

About how much do you spend in bills every month that report to credit bureaus? (such as credit cards &  loans)
$

About how much did you make last year from real income reported to the IRS? 
$

Questions:                                             (Check All That Apply)                                                     Yes

Are there any outstanding judgments against you?                                                                                       

        If Yes Checked, Please List How Much is Approximately Outstanding $

Have you been declared bankrupt within the past 7 years?                                                                            

        If Yes Checked, Please List If/If Not Discharged & When

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?                  

        If Yes Checked, Please List When Foreclosure was finalized 

Are you a party to a lawsuit?                                                                                                                          

        If Yes Checked, Please List What Type 

Have you directly or indirectly been obligated on any loan which resulted in                                                
foreclosure, transfer of title in lieu of foreclosure, or judgment?  
(This would include such loans as home mortgage loans, SBA loans, home improvement
loans, educational loans, manufactured (mobile) home loans, any mortgage, financial
obligation, bond, or loan guarantee. 

        If Yes Checked, Please List When Foreclosure was finalized 

Are you presently delinquent or in default on any                                                                                             
Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?                           

        If Yes Checked, Please List How Much is Approximately Outstanding  $

Are you obligated to pay alimony, child support, or separate maintenance?                                                 

        If Yes Checked, Please List How Much You Pay Monthly  $

Is any part of the down payment borrowed?                                                                                                   

        If Yes Checked, Please List How Much is Borrowed    $

Are you a co-maker or endorser on a note?                                                                                                    

Are you a U. S. citizen?                                                                                                                                  

Are you a permanent resident alien?                                                                                                             

Do you intend to occupy the property as your primary residence?                                                                 

            If "Yes," complete question m below.

            Have you owned a property in the last three years?                                                                          

            What type of property did you own-principal residence (PR) second home (SH) or investment property (IP) ?

            How did you hold title to the home-solely by yourself (S) , jointly w/ your spouse (SP) , or jointly w/ another person (O) ?

Please provide us with further Comments Such as best time to call you or any Questions you may have: