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 HOME PHONE WORK PHONE BEST TIME TO CONTACT (please select) Morning at Home Morning at Work Afternoon at Home Afternoon at Work Evening at Home Late Evening at Home TYPE OF LOAN DESIRED (please Select) Fixed Adjustable Balloon Other Undecided LOAN AMOUNT DESIRED CASH DESIRED AT CLOSING (estimates are ok)   WHAT IS YOUR LOAN GOAL? (please select) looking for a lender and comparing loans Have lender, but looking at other options I am just checking rates TYPE OF HOME OWNED (please select) Single Family Detached Duplex Townhouse Condominium Cooperative Manufactured/Modular ESTIMATED VALUE OF HOME PROPERTY USE (please select) Primary Residence Second/Vacation Property Investment Property 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% RATE TYPE (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% RATE TYPE (select type) Fixed Variable     RATE YOUR CREDIT (please select) Excellent Good Fair Poor EMPLOYMENT STATUS (please select) Employed Self-Employed Retired Not Employed PLACE OF EMPLOYMENT YEARS AT COMPANY MONTHLY PAYMENTS GROSS MONTHLY HOUSEHOLD INCOME PLEASE ENTER INFORMATION THAT YOU FEEL IS IMPORTANT TO THE LENDERS.