First Name

Last Name

Address

City

State

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Zip

E-Mail

Home Telephone

Work Telephone

Best Time to Call

Please SelectCall Me NowHome-MorningHome-AfternoonHome-EveningWork-MorningWork-AfternoonWork-Evening

Employer Name

Occupation

Time on Job

Select Years1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years14 Years15 Years16 Years17 Years18 Years19 Years20 Years20 Years +Months1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months

Monthly Gross Income

Please SelectLess Than $500.00$500$600$700$800$900$1,000$1,100$1,200$1,300$1,400$1,500$1,600$1,700$1,800$1,900$2,000$2,100$2,200$2,300$2,400$2,500$2,600$2,700$2,800$2,900$3,000$3,100$3,200$3,300$3,400$3,500$3,600$3,700$3,800$3,900$4,000$4,100$4,200$4,300$4,400$4,500$4,600$4,700$4,800$4,900$5,000$5,100$5,200$5,300$5,400$5,500$5,600$5,700$5,800$5,900$6,000$6,100$6,200$6,300$6,400$6,500$6,600$6,700$6,800$6,900$7,000$7,100$7,200$7,300$7,400$7,500Over $7,500

Credit Rating

Please SelectExcellentGoodFairPoor

Credit Score (if available)

First Name

Last Name

Employer Name

Occupation

Time on Job

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Monthly Gross Income

Please SelectLess Than $500.00$500$600$700$800$900$1,000$1,100$1,200$1,300$1,400$1,500$1,600$1,700$1,800$1,900$2,000$2,100$2,200$2,300$2,400$2,500$2,600$2,700$2,800$2,900$3,000$3,100$3,200$3,300$3,400$3,500$3,600$3,700$3,800$3,900$4,000$4,100$4,200$4,300$4,400$4,500$4,600$4,700$4,800$4,900$5,000$5,100$5,200$5,300$5,400$5,500$5,600$5,700$5,800$5,900$6,000$6,100$6,200$6,300$6,400$6,500$6,600$6,700$6,800$6,900$7,000$7,100$7,200$7,300$7,400$7,500Over $7,500

Credit Rating

Please SelectExcellentGoodFairPoor

Credit Score (if available)

Refinancing or Home Equity

Property Type

Please SelectSingle Family2 - 4 UnitLog HomeRanch

Time in Home

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Loan Type

Please SelectFHAVAConventionalJumboPERSCal-VetPrivate PartyNo Mortgage

Mortgage Company

Current Rate

Please Select5.500%5.625%5.750%5.875%6.000%6.100%6.250%6.375%6.500%6.625%6.750%6.875%7.000%7.100%7.250%7.375%7.500%7.625%7.750%7.875%8.000%8.100%8.250%8.375%8.500%8.625%8.750%8.875%9.000%9.100%9.250%9.375%9.500%9.625%9.750%9.875%10.000%Over 10%

Mortgage Payment

Mortgage Balance

Purchase Price

Current Value

Purchase

Property Type

Please SelectSingle Family2 - 4 UnitManufactured HomeCondominiumCo Op

Purchase Price

%Down Payment

Please Select0 Down3% Down5% Down10% Down15% Down20% Down25% Down30% Down35% Down40% Down45% Down50% Down55% Down60% Down65% Down70% Down75% Down

Closing Date

Please SelectStill Home Searching1-2 weeks2-3 weeks3-4 weeks4-5 weeks5-6 weeks6-7 weeks7-8 weeks

Communication

Please SelectPlease E-mail Detailed InformationPlease Overnight Mail Detailed InformationPlease Call Me With Detailed Information

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