*  What is your First Name?   

*  What is your Work Number?   

*  And what is your Cell/Mobile Phone Number?   

*  What is your Email Address (YourName@YourDomain.com)?   

And what is your Fax Number?   

*  What is your social security number?   

*  What is your date of birth?

*  Is there a Co-Borrower on your home loan?   

Choose Yes No Do Not Know

*  Are you Married to Co-Borrower?

Choose Wife Husband Other Both

And what is the co-borrower’s social?   

What is the co-borrower's date of birth?

*  What is the Property Address that your seeking financing for?   

*  What is your objective?

*  How much Cash do you Need?

  (Hold the Control Key Down to choose Multiple)

*  What is your Payment on the your Mortgage?   

*  Does that payment include your taxes and insurance?   

Choose Negative Amortization Interest Only Principal-Interest Principal-Interest-Taxes-Insurance Principal-Interest-Taxes Principal-Interest-Insurance

*  Who is your 1st Lender?   

*  What kind of Loan Type is it?   

Choose 30 Fixed Rate 15 Fixed Rate 10 Year Fixed 7 Year Fixed 5 Year Fixed 3 Year Fixed 2 Year Fixed Balloon Adjustable Refused Do Not Know Not On Here

*  What is your Interest Rate?   

Choose Not on Here No Loan Purchase 3.500% 3.625% 3.750% 3.875% 4.000% 4.125% 4.250% 4.375% 4.500% 4.625% 4.750% 4.875% 5.000% 5.125% 5.250% 5.375% 5.500% 5.625% 5.750% 5.875% 6.000% 6.125% 6.250% 6.375% 6.500% 6.625% 6.750% 6.875% 7.000% 7.125% 7.250% 7.375% 7.500% 7.625% 7.750% 7.875% 8.000% 8.125% 8.250% 8.375% 8.500% 8.625% 8.750% 8.875% 9.000% 9.125% 9.250% 9.375% 9.500% 9.625% 9.750% 9.875% 10.000 10.125 10.250 10.375 10.500 10.625 10.750 10.875 11.000 11.125 11.250 11.375 11.500 11.625 11.750 11.875 12% +

*  Do you have any other loans on the property?   

Choose No Yes-Just a 2nd Loan Yes-2nd and 3rd

What is the Loan Amount on the 2nd Mortgage?   

What is your Payment on the 2nd Mortgage?   

What is your Interest Rate on the 2nd Mortgage?     

Choose No Loan Not On Here Purchase Below 4.500% 4.500% 4.625% 4.750% 4.875% 5.000% 5.125% 5.250% 5.375% 5.500% 5.625% 5.750% 5.875% 6.000% 6.125% 6.250% 6.375% 6.500% 6.625% 6.750% 6.875% 7.000% 7.125% 7.250% 7.375% 7.500% 7.625% 7.750% 7.875% 8.000% 8.125% 8.250% 8.375% 8.500% 8.625% 8.750% 8.875% 9.000% 9.125% 9.250% 9.375% 9.500% 9.625% 9.750% 9.875% 10.000 10.125 10.250 10.375 10.500 10.625 10.750 10.875 11.000 11.125 11.250 11.375 11.500 11.625 11.750 11.875 12% +

Who is your Lender for this 2nd Mortgage?   

What kind of Loan Type is it?   

Choose Home Equity Line 30 Fixed Rate 15 Fixed Rate 10 Year Fixed 7 Year Fixed 5 Year Fixed 3 Year Fixed 2 Year Fixed Balloon Adjustable Refused Do Not Know

What is the loan Amount on your 3rd?   

*  Employed, Self Employed, Disabled or Retired?  

Choose Employed Self Employed Retired Temporary Disability Perminant Disability

*  How do you get paid?

*  Who is your Employer?

*  Borrower Gross Monthly Income?

*  Are we allowed to call you at Work?   

*  What year did you start working there?   

*  How long have you been in that Industry?   

*  Borrower Job Title?   

Borrower Income Comments?   

*  Please add up all liquid cash in Checking, Savings, Stocks, IRA's, Money Markets, Mutual Funds & 401k accounts  

*  Year Make and Model of 1st Car?   

Year Make and Model of 2nd Car?   

Who do you bank with?   

What is the balance of that account?   

Co-Borrower Employer?

Co-Borrower Gross Monthly Income?

What is the Co-Borrower Work Number?   

What year did the Co-Borrower start working there?   

How long has the Co-Borrower been in that Industry?   

Co-Borrower Job Title?   

Co-Borrower Income Comments?   

*  Primary Program Interested and Quoted? 

*  Other Programs Interested In? 

 (Hold the Control Key Down to choose Multiple)

 What is the address for the 1st Other Property?   

 What is the address for the 2nd Other Property?   

 What is the address for the 3rd Other Property?   

*  In order to get you the best rate, we will need to run a credit—okay?   

Choose Yes No

Representative Comments and Customer Notes: