Let's Start by Telling Us What Product You Want

1. What Type of Loan: SELECT LOAN TYPE Refinance Home Purchase Debt Consolidation Home Equity

Tell Us About Your Property

1. Property Location: SELECT LOCATION 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
2. Property Zip Code: - (12345 or 12345-6789)
3. Property Area Code:
4. Home Description: SELECT DESCRIPTION Single Family Multi Family Town House Condo No mobile or manufactured homes
5. Purchase Year: SELECT YEAR 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945
6. Property Use: SELECT PURPOSE Primary Residence Second or Vacation Home Investment Property
7. When Likely to Buy: SELECT TIME FRAME Immediately 30 Days 60 Days 90 Days No Time Constraint
8. Have You Found the Home: Yes   No
9. Do You Have a Contract: Yes   No
10. Do You Have R/E Agent: Yes   No
11. Agent Name:
12. Agent Phone: (555-5555-5555)
13. Agent Name:

Tell Us About Your Loan

1. Purpose of the Loan: SELECT PURPOSE Lower Monthly Payment Lower Interest Rate Change Terms Pay Off Debt Make Home Improvements Take Out Cash
2. Estimated Home Value: SELECT VALUE 75,000 - 80,000 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001 - 110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 200,001 - 210,000 210,001 - 220,000 220,001 - 230,000 230,001 - 240,000 240,001 - 250,000 250,001 - 260,000 260,001 - 270,000 270,001 - 280,000 280,001 - 290,000 290,001 - 300,000 300,001 - 310,000 310,001 - 320,000 320,001 - 330,000 330,001 - 340,000 340,001 - 350,000 350,001 - 360,000 360,001 - 370,000 370,001 - 380,000 380,001 - 390,000 390,001 - 400,000 400,001 - 420,000 420,001 - 440,000 440,001 - 460,000 460,001 - 480,000 480,001 - 500,000 500,001 - 520,000 520,001 - 540,000 540,001 - 560,000 560,001 - 580,000 580,001 - 600,000 600,001 - 620,000 620,001 - 640,000 640,001 - 660,000 660,001 - 680,000 680,001 - 700,000 700,001 - 720,000 720,001 - 740,000 740,001 - 760,000 760,001 - 780,000 780,001 - 800,000 800,001 - 820,000 820,001 - 840,000 840,001 - 860,000 860,001 - 880,000 880,001 - 900,000 900,001 - 920,000 920,001 - 940,000 940,001 - 960,000 960,001 - 980,000 980,001 - 1,000,000 Over 1,000,000 $
3. Down Payment Amount: SELECT AMOUNT 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Other %
4. .00 $
5. First Mortgage Balance: SELECT RANGE 50,000 - 55,000 55,001 - 60,000 60,001 - 65,000 65,001 - 70,000 70,001 - 75,000 75,001 - 80,000 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001 - 110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 200,001 - 210,000 210,001 - 220,000 220,001 - 230,000 230,001 - 240,000 240,001 - 250,000 250,001 - 260,000 260,001 - 270,000 270,001 - 280,000 280,001 - 290,000 290,001 - 300,000 300,001 - 310,000 310,001 - 320,000 320,001 - 330,000 330,001 - 340,000 340,001 - 350,000 350,001 - 360,000 360,001 - 370,000 370,001 - 380,000 380,001 - 390,000 390,001 - 400,000 400,001 - 420,000 420,001 - 440,000 440,001 - 460,000 460,001 - 480,000 480,001 - 500,000 500,001 - 520,000 520,001 - 540,000 540,001 - 560,000 560,001 - 580,000 580,001 - 600,000 600,001 - 620,000 620,001 - 640,000 640,001 - 660,000 660,001 - 680,000 680,001 - 700,000 700,001 - 720,000 720,001 - 740,000 740,001 - 760,000 760,001 - 780,000 780,001 - 800,000 800,001 - 820,000 820,001 - 840,000 840,001 - 860,000 860,001 - 880,000 880,001 - 900,000 900,001 - 920,000 920,001 - 940,000 940,001 - 960,000 960,001 - 980,000 980,001 - 1,000,000 1,000,000+ 1,500,000+ 2,000,000+ $
6. First Mortgage Rate: SELECT RATE 3.00 3.25 3.50 3.75 4.00 4.25 4.50 4.75 5.00 5.25 5.50 5.75 6.00 6.25 6.50 6.75 7.00 7.25 7.50 7.75 8.00 8.25 8.50 8.75 9.00 9.25 9.50 9.75 10.00 10.25 10.50 10.75 11+ %
7. Existing Rate Type: SELECT RATE TYPE Fixed Rate Adjustable Rate I Don't Know
8. Have Second Mortgage: Yes   No
9. Second Mortgage Balance: SELECT RANGE 1 - 5,000 5,001 - 10,000 10,001 - 15,000 15,001 - 20,000 20,001 - 25,000 25,001 - 30,000 30,001 - 35,000 35,001 - 40,000 40,001 - 45,000 45,001 - 50,000 50,001 - 55,000 55,001 - 60,000 60,001 - 65,000 65,001 - 70,000 70,001 - 75,000 75,001 - 80,000 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001 - 110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 Over 200,000 $
10. Second Mortgage Rate: SELECT RATE 3.00 3.25 3.50 3.75 4.00 4.25 4.50 4.75 5.00 5.25 5.50 5.75 6.00 6.25 6.50 6.75 7.00 7.25 7.50 7.75 8.00 8.25 8.50 8.75 9.00 9.25 9.50 9.75 10.00 10.25 10.50 10.75 11+ %
11. Additional Cash to Borrow: SELECT AMOUNT 0 1 - 5,000 5,001 - 10,000 10,001 - 15,000 15,001 - 20,000 20,001 - 25,000 25,001 - 30,000 30,001 - 35,000 35,001 - 40,000 40,001 - 45,000 45,001 - 50,000 50,001 - 55,000 55,001 - 60,000 60,001 - 65,000 65,001 - 70,000 70,001 - 75,000 75,001 - 80,000 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001 - 110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 200,001 - 210,000 210,001 - 220,000 220,001 - 230,000 230,001 - 240,000 240,001 - 250,000 250,001 - 260,000 260,001 - 270,000 270,001 - 280,000 280,001 - 290,000 290,001 - 300,000 300,001 - 310,000 310,001 - 320,000 320,001 - 330,000 330,001 - 340,000 340,001 - 350,000 350,001 - 360,000 360,001 - 370,000 370,001 - 380,000 380,001 - 390,000 390,001 - 400,000 400,001 - 420,000 420,001 - 440,000 440,001 - 460,000 460,001 - 480,000 480,001 - 500,000 500,001 - 520,000 520,001 - 540,000 540,001 - 560,000 560,001 - 580,000 580,001 - 600,000 600,001 - 620,000 620,001 - 640,000 640,001 - 660,000 660,001 - 680,000 680,001 - 700,000 700,001 - 720,000 720,001 - 740,000 740,001 - 760,000 760,001 - 780,000 780,001 - 800,000 800,001 - 820,000 820,001 - 840,000 840,001 - 860,000 860,001 - 880,000 880,001 - 900,000 900,001 - 920,000 920,001 - 940,000 940,001 - 960,000 960,001 - 980,000 980,001 - 1,000,000 1,000,000+ 1,500,000+ 2,000,000+

Tell Us About Your Personal Finances

1. Your Credit Status: SELECT CREDIT STATUS Excellent Good Fair Poor
2. Your Annual Income: SELECT ANNUAL INCOME Less than 30,000 30,000 – 44,999 45,000 – 59,999 60,000 – 74,999 75,000 – 89,999 90,000 – 104,999 105,000 – 120,000 Over 120,000 $
3. Occupational Status: SELECT STATUS Employed Self Employed Retired Not Employed
4. Bankruptcy Status: SELECT STATUS No/Not in Past 7 Years 5 – 7 Years Ago 2 – 5 Years Ago 1 – 2 Years Ago Less Than 12 Months Ago
5. Monthly Debt Payments: SELECT MONTHLY PAYMENTS 0 - 249 250 - 499 500 - 749 750 - 1,000 Over 1,000 $ (do not include housing)
6. First-Time Home Buyer: Yes   No

Your Contact Information

1. First Name:
2. Last Name:
3. Street Address:
4. City:
5. State: SELECT STATE 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
6. Zip: (12345 or 12345-6789)
7. E-mail: (user@domain.com)
8. Primary Phone: (555-5555-5555)
9. Secondary Phone: (555-5555-5555)
10. Best Contact Time: SELECT BEST CONTACT TIME Morning on Primary Afternoon on Primary Evening on Primary Morning on Secondary Afternoon on Secondary Evening on Secondary

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