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Applicant Information  * First Name:  * Last Name:  * Daytime Telephone Number:     Alternate Telephone Number:     Best Time To Call: Morning Afternoon Evening  * Email Address:  * Rate your credit: Select from list Excellent Good Fair Poor     Are you self employed? Yes No  * Approximate monthly income: $      Is there a co-applicant on the     current loan? Yes No  Co-Applicant Information     First Name:  Last Name:  Co-applicant credit: Select from list Excellent Good Fair Poor     Approximate monthly     co-applicant income: $      Is the co-applicant self employed? Yes No  Property Information  * Property Type: Select from list Single Family Residence Condo Manufactured Home Duplex Triplex Fourplex  * Street:  * City:  * Zip:  * State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri 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  * Estimated Property Value: $      Owner occupied: Yes No  Loan Information  * 1st Mortgage Lender  * 1st Mortgage Loan Type: Select from list 30-year fixed 15-year fixed 5-year fixed 3-year fixed then adjustable 2-year fixed then adjustable Negative Amortization Adjustable Other  * 1st Mortgage Balance: $   * 1st Mortgage Interest Rate: %  * Monthly Payment: $      Does your payment include taxes     and insurance? Yes No     Do you have a prepayment     penalty? Yes NoNot Sure     Do you have a 2nd loan? Yes No     2nd Mortgage Lender     2nd Mortgage Loan Type: Select from list 30-year fixed 15-year fixed 5-year fixed 3-year fixed then adjustable 2-year fixed then adjustable Negative Amortization Adjustable Other     2nd Mortgage Balance: $      2nd Mortgage Interest Rate: %     Do you have a prepayment     penalty on your 2nd loan? Yes NoNot Sure  Additional Information     Purpose for refinancing: Reduce Rate Reduce Payment Shorten Term Convert Adjustable to Fixed Cash out for consolidation Cash Out for Other Purposes     Desired Cash Out: $      Additional Comments:

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