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payments into half. Replace your existing
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Loan Information
Where is the
property located?
Property
State ?
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
Property ZIP
code
Property area
code
Property Type
Single
Family
Multi Family
Town House
Condo
(No
mobile or manufactured homes)
Property Purchase
year
Purchase
Year ?
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
Property use
Primary Residence
Second
or Vacation Home
Investment
Property
�
Estimated
Credit Rating
Excellent
Good
Fair
Poor
When are you
likely to buy a home?
Time to
Purchase ?
Immediately
30 Days
60 Days
90 Days
No
Time Constraint
Have you found
a home?
Yes No
Do you have a
signed contract to buy your home?
Yes No
Do you have a
real estate agent?
Yes No
Agent name
Agent phone
Agent company
(example:
Prudential, Remax)
Loan Purpose
Loan Purpose
?
Lower
Monthly Payment
Lower
Interest Rate
Change
Terms
Pay
Off Debt
Make
Home Improvements
Take
Out Cash
Estimated home
value
Estimated
Home Value ?
75,000 - 80,000
80,001 - 85,000
85,001 - 90,000
90,001 - 95,000
95,001 - 100,000
100,001 - 105,000
105,001 - 110,000
110,001 - 115,000
115,001 - 120,000
120,001 - 125,000
125,001 - 130,000
130,001 - 135,000
135,001 - 140,000
140,001 - 145,000
145,001 - 150,000
150,001 - 155,000
155,001 - 160,000
160,001 - 165,000
165,001 - 170,000
170,001 - 175,000
175,001 - 180,000
180,001 - 185,000
185,001 - 190,000
190,001 - 195,000
195,001 - 200,000
200,001 - 210,000
210,001 - 220,000
220,001 - 230,000
230,001 - 240,000
240,001 - 250,000
250,001 - 260,000
260,001 - 270,000
270,001 - 280,000
280,001 - 290,000
290,001 - 300,000
300,001 - 310,000
310,001 - 320,000
320,001 - 330,000
330,001 - 340,000
340,001 - 350,000
350,001 - 360,000
360,001 - 370,000
370,001 - 380,000
380,001 - 390,000
390,001 - 400,000
400,001 - 420,000
420,001 - 440,000
440,001 - 460,000
460,001 - 480,000
480,001 - 500,000
500,001 - 520,000
520,001 - 540,000
540,001 - 560,000
560,001 - 580,000
580,001 - 600,000
600,001 - 620,000
620,001 - 640,000
640,001 - 660,000
660,001 - 680,000
680,001 - 700,000
700,001 - 720,000
720,001 - 740,000
740,001 - 760,000
760,001 - 780,000
780,001 - 800,000
800,001 - 820,000
820,001 - 840,000
840,001 - 860,000
860,001 - 880,000
880,001 - 900,000
900,001 - 920,000
920,001 - 940,000
940,001 - 960,000
960,001 - 980,000
980,001 - 1,000,000
Over 1,000,000
Down payment
amount
Down Payment
Amount
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Other
.00
First mortgage
balance
First
Balance ?
50,000 - 55,000
55,001 - 60,000
60,001 - 65,000
65,001 - 70,000
70,001 - 75,000
75,001 - 80,000
80,001 - 85,000
85,001 - 90,000
90,001 - 95,000
95,001 - 100,000
100,001 -
105,000
105,001 -
110,000
110,001 -
115,000
115,001 -
120,000
120,001 -
125,000
125,001 -
130,000
130,001 -
135,000
135,001 -
140,000
140,001 -
145,000
145,001 -
150,000
150,001 -
155,000
155,001 -
160,000
160,001 -
165,000
165,001 -
170,000
170,001 -
175,000
175,001 -
180,000
180,001 -
185,000
185,001 -
190,000
190,001 -
195,000
195,001 -
200,000
200,001 -
210,000
210,001 -
220,000
220,001 -
230,000
230,001 -
240,000
240,001 -
250,000
250,001 -
260,000
260,001 -
270,000
270,001 -
280,000
280,001 -
290,000
290,001 -
300,000
300,001 -
310,000
310,001 -
320,000
320,001 -
330,000
330,001 -
340,000
340,001 -
350,000
350,001 -
360,000
360,001 -
370,000
370,001 -
380,000
380,001 -
390,000
390,001 -
400,000
400,001 -
420,000
420,001 -
440,000
440,001 -
460,000
460,001 -
480,000
480,001 -
500,000
500,001 -
520,000
520,001 -
540,000
540,001 -
560,000
560,001 -
580,000
580,001 -
600,000
600,001 -
620,000
620,001 -
640,000
640,001 -
660,000
660,001 -
680,000
680,001 -
700,000
700,001 -
720,000
720,001 -
740,000
740,001 -
760,000
760,001 -
780,000
780,001 -
800,000
800,001 -
820,000
820,001 -
840,000
840,001 -
860,000
860,001 -
880,000
880,001 -
900,000
900,001 -
920,000
920,001 -
940,000
940,001 -
960,000
960,001 -
980,000
980,001 -
1,000,000
1,000,000+
1,500,000+
2,000,000+
First mortgage
interest rate
Select
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+
%
Existing Desired
rate type
Fixed
Rate
Adjustable
Rate
I
Don't Know
Do
you have a second mortgage?
Yes
No
Second mortgage
balance
Second
Balance ?
1 - 5,000
5,001 - 10,000
10,001 - 15,000
15,001 - 20,000
20,001 - 25,000
25,001 - 30,000
30,001 - 35,000
35,001 - 40,000
40,001 - 45,000
45,001 - 50,000
50,001 - 55,000
55,001 - 60,000
60,001 - 65,000
65,001 - 70,000
70,001 - 75,000
75,001 - 80,000
80,001 - 85,000
85,001 - 90,000
90,001 - 95,000
95,001 - 100,000
100,001 -
105,000
105,001 -
110,000
110,001 -
115,000
115,001 -
120,000
120,001 -
125,000
125,001 -
130,000
130,001 -
135,000
135,001 -
140,000
140,001 -
145,000
145,001 -
150,000
150,001 -
155,000
155,001 -
160,000
160,001 -
165,000
165,001 -
170,000
170,001 -
175,000
175,001 -
180,000
180,001 -
185,000
185,001 -
190,000
190,001 -
195,000
195,001 -
200,000
Over 200,000
�
Second
mortgage interest rate
Select
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+
%
�
How
much additional cash would you like How
much cash do you want for your How
much debt do you wish to consolidate?
Additional
Cash?
0
1 - 5,000
5,001 - 10,000
10,001 - 15,000
15,001 - 20,000
20,001 - 25,000
25,001 - 30,000
30,001 - 35,000
35,001 - 40,000
40,001 - 45,000
45,001 - 50,000
50,001 - 55,000
55,001 - 60,000
60,001 - 65,000
65,001 - 70,000
70,001 - 75,000
75,001 - 80,000
80,001 - 85,000
85,001 - 90,000
90,001 - 95,000
95,001 - 100,000
100,001 -
105,000
105,001 -
110,000
110,001 -
115,000
115,001 -
120,000
120,001 -
125,000
125,001 -
130,000
130,001 -
135,000
135,001 -
140,000
140,001 -
145,000
145,001 -
150,000
150,001 -
155,000
155,001 -
160,000
160,001 -
165,000
165,001 -
170,000
170,001 -
175,000
175,001 -
180,000
180,001 -
185,000
185,001 -
190,000
190,001 -
195,000
195,001 -
200,000
200,001 -
210,000
210,001 -
220,000
220,001 -
230,000
230,001 -
240,000
240,001 -
250,000
250,001 -
260,000
260,001 -
270,000
270,001 -
280,000
280,001 -
290,000
290,001 -
300,000
300,001 -
310,000
310,001 -
320,000
320,001 -
330,000
330,001 -
340,000
340,001 -
350,000
350,001 -
360,000
360,001 -
370,000
370,001 -
380,000
380,001 -
390,000
390,001 -
400,000
400,001 -
420,000
420,001 -
440,000
440,001 -
460,000
460,001 -
480,000
480,001 -
500,000
500,001 -
520,000
520,001 -
540,000
540,001 -
560,000
560,001 -
580,000
580,001 -
600,000
600,001 -
620,000
620,001 -
640,000
640,001 -
660,000
660,001 -
680,000
680,001 -
700,000
700,001 -
720,000
720,001 -
740,000
740,001 -
760,000
760,001 -
780,000
780,001 -
800,000
800,001 -
820,000
820,001 -
840,000
840,001 -
860,000
860,001 -
880,000
880,001 -
900,000
900,001 -
920,000
920,001 -
940,000
940,001 -
960,000
960,001 -
980,000
980,001 -
1,000,000
1,000,000+
1,500,000+
2,000,000+
Applicant Details
First Name
Last Name
Annual income
Income ?
Less than 30,000
30,000 44,999
45,000 59,999
60,000 74,999
75,000 89,999
90,000 104,999
105,000 120,000
Over 120,000
Occupational status
Employed
Self Employed
Retired
Not Employed
Have you ever declared
bankruptcy?
No/Not
in Past 7 Years
5 - 7 Years
Ago
2 - 5 Years
Ago
1 - 2 Years
Ago
Less Than
12 Months Ago
Monthly debt
payments
Monthly
Debt ?
0 - 249
250 - 499
500 - 749
750 - 1,000
Over 1,000
