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APPLICANT/CO-APPLICANT INFORMATION     APPLICANT E-MAIL (Appl) CO-APPLICANT E-MAIL (Co-Appl) ADDRESS CITY STATE (please select) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska Nevada New Hampshire New Jersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington West Virginia Wisconsin Wyoming POSTAL CODE Contact Information HOME PHONE WORK PHONE WHAT IS BEST TIME TO CONTACT YOU (please select) Morning at Home Morning at Work Afternoon at Home Afternoon at Work Evening at Home Late Evening at Home Loan Information TYPE OF LOAN DESIRED (please select) Fixed Variable LOAN AMOUNT DESIRED Property Information TYPE OF HOME OWNED (please select) None Single Family Detached Home Condo/Townhouse Multi-Family Dwelling Unit Double Wide Manufactured Home Single Wide Manufactured Home CURRENT VALUE OF HOME ORIGINAL PURCHASE PRICE YEAR PURCHASED FIRST MORTGAGE BALANCE INTEREST RATE (select rate) Less then 3% 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% 11.00% 11.25% 11.50% 11.75% 12.00% 12.25% 12.50% 12.75% 13.00% 13.25% 13.50% 13.75% 14.00% 14.25% 14.50% 14.75% 15.00% Greater the 15% (select type) Fixed Variable SECOND MORTGAGE BALANCE INTEREST RATE (select rate) Less then 3% 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% 11.00% 11.25% 11.50% 11.75% 12.00% 12.25% 12.50% 12.75% 13.00% 13.25% 13.50% 13.75% 14.00% 14.25% 14.50% 14.75% 15.00% Greater the 15% (select type) Fixed Variable MONTHLY PAYMENTS IF BEHIND ON PAYMENTS (HOW MUCH) NUMBER OF TIMES LATE ON MORTGAGE Credit/Employment/Income Information HOW WOULD YOU RATE YOUR CREDIT (please select) Excellent Good Fair Poor PLACE OF EMPLOYMENT YEARS THERE MONTHLY INCOME MONTHLY DEBT (do not include mortgage/rent) COMMENTS PLEASE ENTER INFORMATION THAT YOU FEEL IS IMPORTANT TO THE LENDERS. *