Loan Information                                                    EASY QUICK QUOTE Loan Type -----Select One ----- RefinanceHome EquityPurchaseDebt Consolidation Estimated Loan Amount -----Select One ----- $90,000 $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $210,000 $220,000 $230,000 $240,000 $250,000 $260,000 $270,000 $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 $340,000 $350,000 $360,000 $370,000 $380,000 $390,000 $400,000 $420,000 $440,000 $460,000 $480,000 $500,000 $520,000 $540,000 $560,000 $580,000 $600,000 $620,000 $640,000 $660,000 $680,000 $700,000 $720,000 $740,000 $760,000 $780,000 $800,000 $820,000 $840,000 $860,000 $880,000 $900,000 $920,000 $940,000 $960,000 $980,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,750,000 $2,000,000+ Property Type ----- Select One ------ Single Family Condominium Town Home Multi family Property Value -----Select One ----- $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $210,000 $220,000 $230,000 $240,000 $250,000 $260,000 $270,000 $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 $340,000 $350,000 $360,000 $370,000 $380,000 $390,000 $400,000 $420,000 $440,000 $460,000 $480,000 $500,000 $520,000 $540,000 $560,000 $580,000 $600,000 $620,000 $640,000 $660,000 $680,000 $700,000 $720,000 $740,000 $760,000 $780,000 $800,000 $820,000 $840,000 $860,000 $880,000 $900,000 $920,000 $940,000 $960,000 $980,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,750,000 $2,000,000+ Property Use -----Select One ----- Primary Residence Investment Secondary Residence Estimated Credit Rating -------Select One ------- Excellent Good, Pay My Bills On Time Fair, Make/Made Some Late Payments Poor, Late On All Payments Property Area Code Where is the Property Located Estimated Close Date   Within 30 Days 30 - 60 Days 60 - 90 Days 90 - 120 Days 120 - 150 Days Desired Interest Rate Type -----Select One----- Fixed Rate Adjustable Rate I Don't Know Have you found a home? Yes No Do you have a real estate agent Yes No Do you have a signed contract to buy your home? Yes No Desired Loan Type -----Select One----- Rate/Term Refinance - Cash Out Home Improvement Debt Consolidation Home Equity Loan Current Interest Rate Type -----Select One----- Fixed Rate Adjustable Rate I Don't Know First Mortgage Balance -----Select One ----- $0 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,999 $100,000 - $109,999 $110,000 - $119,999 $120,000 - $129,999 $130,000 - $139,999 $140,000 - $149,999 $150,000 - $159,999 $160,000 - $169,999 $170,000 - $179,999 $180,000 - $189,999 $190,000 - $199,999 $200,000 - $209,999 $210,000 - $219,999 $220,000 - $229,999 $230,000 - $239,999 $240,000 - $249,999 $250,000 - $259,999 $260,000 - $269,999 $270,000 - $279,999 $280,000 - $289,999 $290,000 - $299,999 $300,000 - $309,999 $310,000 - $319,999 $320,000 - $329,999 $330,000 - $339,999 $340,000 - $349,999 $350,000 - $359,999 $360,000 - $369,999 $370,000 - $379,999 $380,000 - $389,999 $390,000 - $399,999 $400,000 - $419,999 $420,000 - $439,999 $440,000 - $459,999 $460,000 - $479,999 $480,000 - $499,999 $500,000 - $519,999 $520,000 - $539,999 $540,000 - $559,999 $560,000 - $579,999 $580,000 - $599,999 $600,000 - $619,999 $620,000 - $639,999 $640,000 - $659,999 $660,000 - $679,999 $680,000 - $699,999 $700,000 - $719,999 $720,000 - $739,999 $740,000 - $759,999 $760,000 - $779,999 $780,000 - $799,999 $800,000 - $819,999 $820,000 - $839,999 $840,000 - $859,999 $860,000 - $879,999 $880,000 - $899,999 $900,000 - $919,999 $920,000 - $939,999 $940,000 - $959,999 $960,000 - $979,999 $980,000 - $999,999 $1,000,000+ First Mortgage Interest Rate -----Select One ----- 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 Credit Card Debt -----Select One----- $0 Less than $5,000 $5,000 - $9,999 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,999 $100,000+ Payment Status -----Select One ----- Current About to fall behind 31+ behind 61+ behind First Mortgage Balance -----Select One ----- $0 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,999 $100,000 - $109,999 $110,000 - $119,999 $120,000 - $129,999 $130,000 - $139,999 $140,000 - $149,999 $150,000 - $159,999 $160,000 - $169,999 $170,000 - $179,999 $180,000 - $189,999 $190,000 - $199,999 $200,000 - $209,999 $210,000 - $219,999 $220,000 - $229,999 $230,000 - $239,999 $240,000 - $249,999 $250,000 - $259,999 $260,000 - $269,999 $270,000 - $279,999 $280,000 - $289,999 $290,000 - $299,999 $300,000 - $309,999 $310,000 - $319,999 $320,000 - $329,999 $330,000 - $339,999 $340,000 - $349,999 $350,000 - $359,999 $360,000 - $369,999 $370,000 - $379,999 $380,000 - $389,999 $390,000 - $399,999 $400,000 - $419,999 $420,000 - $439,999 $440,000 - $459,999 $460,000 - $479,999 $480,000 - $499,999 $500,000 - $519,999 $520,000 - $539,999 $540,000 - $559,999 $560,000 - $579,999 $580,000 - $599,999 $600,000 - $619,999 $620,000 - $639,999 $640,000 - $659,999 $660,000 - $679,999 $680,000 - $699,999 $700,000 - $719,999 $720,000 - $739,999 $740,000 - $759,999 $760,000 - $779,999 $780,000 - $799,999 $800,000 - $819,999 $820,000 - $839,999 $840,000 - $859,999 $860,000 - $879,999 $880,000 - $899,999 $900,000 - $919,999 $920,000 - $939,999 $940,000 - $959,999 $960,000 - $979,999 $980,000 - $999,999 $1,000,000+ First Mortgage Interest Rate -----Select One ----- 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 Applicant Details Occupational Status -----Select one----- Employed Self Employed Retired Not Employed Have you ever declared bankruptcy? -----Select one----- No/Not in Past 7 Years 5 - 7 Years Ago 2 - 5 Years Ago 1 - 2 Years Ago Less Than 12 Months Ago Annual Income -----Select One ----- $0 - $10,000 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,999 $100,000 - $124,999 $125,000 - $149,999 $150,000+ Monthly Debt Payments -----Select One ----- $0 $1 - $199 $200 - $399 $400 - $599 $600 - $799 $800 - $999 $1,000+ (do not include housing) First Name  Last Name Address State -----Select One ----- 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 Email Address City Home Phone - - Zip Work Phone - - Best Contact Time? -----Select one----- Morning on Primary Afternoon on Primary Evening on Primary Morning on Secondary Afternoon on Secondary Evening on Secondary