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First Name
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Last Name
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Address
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City
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State
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ZIP
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Cell Phone
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Loan Purpose
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Purchase
Refinance
Home Improvement
Refinance – Reason
*
No Cash Out
Cash Out – Debt consolidation
Cash Out – Home Improvement
Cash Out –[Borrower enters info]
Enters Info
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Current Rate
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Current Loan Balance
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Do you have a 2nd mortgage
*
Yes
No
Occupancy
*
Owner Occupied
Second Home
Investment Property
Property Type
*
Single Family Residence
Townhome
Condominium
2-4 Units
Manufactured
Mobile
Estimated Value
*
Credit Score
*
800+
750-800
700-749
650-699
620 – 649
Less than 620
Employment Type
*
Employed
Self-Employed
Retired
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