1. Required Personal Information
First Name:
Last Name:
Address:
City, State & Zip:	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Phone Number:	( ) -
Fax Number:	( ) -
Email Address:

2. Loan Information
Type of Loan:	Purchase  Refinance
Is the borrower willing to pay Discount Points to lower their interest rate?	Yes  No
What is the Maximum Discount Points your borrower is willing to pay? 0.10% 0.20% 0.30% 0.40% 0.50% 0.60% 0.70% 0.80% 0.90% 1.00% 1.25% 1.50% 1.75% 2.00% 2.25% 2.50% 2.75% 3.00% 3.25% 3.50% 3.75% 4.00%
3. Financial Information
Sales Price: $ Down Payment: $ or % Estimated Property Value: $ 1st Mortgage Balance: $ Second Mortgage Balance: $ Balance of Debts to be paid off at closing (i.e. debts you wish to consolidate or payoff): $ Cash out desired (if any): $   Loan Amount: $
Gross Monthly Income (Pre-Tax):	$
Minimum Monthly Debt Payments (DO NOT include the debts that you are planning to pay off with this refinance):	$
4. Other Information
Property Use:	Home Second/Vacation Home Rental/Investment
Are you self-employed?	Yes  No
If you can document your income by providing business and/or personal tax returns, financial statements, etc., select Full Documentation below. If not, select Stated below. Income Documentation: Full Documentation  Stated
My Credit Rating Is:	Perfect Excellent Good Fair Poor I know my credit score
Exact Credit Score:
5. Information to calculate your savings (optional) Current mortgage payment (without taxes and insurance): $ Current monthly payments on debts to be paid off with this refinance: $