Pre-Qualification Information: 

Did you find our site on a search engine?    Yes  No   
If yes, please specify:
Alta Vista  Excite  Hot Bot   Lycos   MSN   AOL   Google   Yahoo  Other search engine
Did you hear about us on:
Local TV                  Please type in TV station
Radio station           Please type in radio station
Newspaper              Please type in newspaper
Other                  .     Please type in source
Loan Amount:

Type of Loan:
Purchase Refinance  Second Home Rental Property Second mortgage
Type of Financing:
Fixed Rate  Adjustable Rate  Interest Only Other

Customer Information

Borrower: 

Co-Borrower:  

E-mail: 

Current Street Address: 

City:    State:    Zip Code: 

Home Phone:    Cell Phone:

Work Phone: (Include extension if applicable)

Property Information

Purchase Price -- OR -- Current Value of Property if Refinance: 


Cash Down payment: (If Purchase)


Property Address:    

Property City:    

Property State:    Property Zip Code: 

Property Type:
Single Family  Condo/Townhouse  Mobile Home

Will you occupy the property?:
Yes  No

If purchasing, do you have a Realtor with whom you are working?
Yes  No

Would you like for us to recommend a Realtor who specializes in your area?
Yes  No

Credit Information

How would you rate your Credit?  Excellent   Good   Fair   Poor

Borrower Employment Status:              Co-Borrower Employment Status:
Salaried/Hourly Self Employed        Salaried/Hourly  Self Employed

Borrower Employer:                            Co-Borrower Employer                     
                                
Number of years with Company:           Number of years with Company:
                                                          
Borrower Gross Monthly Income:          Co-Borrower Gross Monthly Income:
                                                 
Liquid Assets: (Include checking, savings, stocks, mutual funds etc.)
                                                 
Borrower Retirement and 401k:            Co-Borrower Retirement and 401k:
                                                 
Borrower Monthly Auto Payments:         Co-Borrower Monthly Auto Payments:
                                                 
Borrower Credit Card (Min. Mo. Pmt)    CoBorrower Credit Card (Min. Mo. Pmt.)
                                                 
Other Monthly Debt: (Child Support, Student Loans. Do not include current house  payment, rent or utilities)

If refinancing, enter outstanding balance owed on first mortgage:

If refinancing, enter outstanding balance owed on second mortgage:

What is your Current Interest Rate?:

Type of Current Loan:
Conventional   FHA  VA   Other
Current Monthly Payment (excluding taxes & insurance):

Annual Property Taxes:            Annual Property Insurance:
                                              
Do you currently have Mortgage Insurance?:
Yes No
Do you have a Second Mortgage or a line of credit on the Subject Property?:
Yes No
Do you want to keep this loan or consolidate it with the first mortgage? 
Keep  Consolidate

Any additional information?  Tell us what you'd like to do.  Type in box below: