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General Section
Contact Information
Name	:
Home Phone	:
Work Phone	:
E-mail	:
Best time to be reached	:
Propert Location
City	:
State	:
Personal Information
Annual Household Income is $	:
My Credit History Is	:		Excellent
			Good, But Some payments late in 200_
			Some Credit Problems as collections in 200_
			Major Credit Problems as judgment bankruptcy or foreclosure
			Don't Know
Loan Amount
Loan amount desired is $
Type of Loan	:		30 yr fixed
			15 yr fixed
			Adjustable
			Commercial
			I do not know
			Other , Please State
Refinance Section
Property Value	:		The property should appraise for $
			Don't know
Existing Loans On Property
1st loan balance $	:
2nd loan balance $	:
3rd loan balance $	:
Reason for Refinancing	:		Reduce Interest rates
			Change from fixed to adjustable
			Change from adjustable to fixed
			Need cash out. Cash out required $
			Other, Please Specify
Current Loan Type	:		Fixed
			Adjustable
			Other, Please Specify