CUSTOMER INFORMATION      30 second quick form First Name Last Name E-mail Address Home Phone Work Phone - - - - Mobile Phone Preferred Contact Time - - Morning Afternoon Evening Address City State Zip Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire NewJersey 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 LOAN INFORMATION Type of Loan: Loan Amount - Select - Home Purchase Refinance Debt Consolidation Second Mortgage and Equity Loan Home Improvement 1,000,000 + 975,000-999,999 950,000-974,999 925,000-949,999 900,000-924,999 875,000-899,999 850,000-874,999 825,000-849,999 800,000-824,999 775,000-799,999 750,000-774,999 725,000-749,999 700,000-724,999 675,000-699,999 650,000-674,999 625,000-649,999 600,000-624,999 575,000-599,999 550,000-574,999 525,000-549,999 500,000-524,999 475,000-499,999 470,000-474,999 465,000-469,999 460,000-464,999 455,000-459,999 450,000-454,999 445,000-449,999 440,000-444,999 435,000-439,999 430,000-434,999 425,000-429,999 420,000-424,999 415,000-419,999 410,000-414,999 405,000-409,999 400,000-404,999 395,000-399,999 390,000-394,999 385,000-389,999 380,000-384,999 375,000-379,999 370,000-374,999 365,000-369,999 360,000-364,999 355,000-359,999 350,000-354,999 345,000-349,999 340,000-344,999 335,000-339,999 330,000-334,999 325,000-329,999 320,000-324,999 315,000-319,999 310,000-314,999 305,000-309,999 300,000-304,999 295,000-299,999 292,500-294,999 290,000-292,499 287,500-289,999 285,000-287,499 282,500-284,999 280,000-282,499 277,500-279,999 275,000-277,499 272,500-274,999 270,000-272,499 267,500-269,999 265,000-267,499 262,500-264,999 260,000-262,499 257,500-259,999 255,000-257,499 252,500-254,999 250,000-252,499 247,500-249,999 245,000-247,499 242,500-244,999 240,000-242,499 237,500-239,999 235,000-237,499 232,500-234,999 230,000-232,499 227,500-229,999 225,000-227,499 222,500-224,999 220,000-222,499 217,500-219,999 215,000-217,499 212,500-214,999 210,000-212,499 207,500-209,999 205,000-207,499 202,500-204,999 200,000-202,499 197,500-199,999 195,000-197,499 192,500-194,999 190,000-192,499 187,500-189,999 185,000-187,499 182,500-184,999 180,000-182,499 177,500-179,999 175,000-177,499 172,500-174,999 170,000-172,499 167,500-169,999 165,000-167,499 162,500-164,999 160,000-162,499 157,500-159,999 155,000-157,499 152,500-154,999 150,000-152,499 147,500-149,999 145,000-147,499 142,500-144,999 140,000-142,499 137,500-139,999 135,000-137,499 132,500-134,999 130,000-132,499 127,500-129,999 125,000-127,499 122,500-124,999 120,000-122,499 117,500-119,999 115,000-117,499 112,500-114,999 - Select - 110,000-112,499 107,500-109,999 105,000-107,499 102,500-104,999 100,000-102,499 97,500-99,999 95,000-97,499 92,500-94,999 90,000-92,499 87,500-89,999 85,000-87,499 82,500-84,999 80,000-82,499 77,500-79,999 75,000-77,499 72,500-74,999 70,000-72,499 67,500-69,999 65,000-67,499 62,500-64,999 60,000-62,499 Property Type My Credit Is - Select - Single Family Residence Condo Townhouse 2-4 Plex Other - Select - Excellent Good Fair Major Problems Interest Rate Home Value Mortgage Balance - Select - 3% - 4% 4% - 5% 5% - 6% 6% - 7% 7% - 8% 8% - 9% 9% - 10% 10% - 11% 11% - 12% 12% - 13% 13% or higher 1,000,000 + 975,000-999,999 950,000-974,999 925,000-949,999 900,000-924,999 875,000-899,999 850,000-874,999 825,000-849,999 800,000-824,999 775,000-799,999 750,000-774,999 725,000-749,999 700,000-724,999 675,000-699,999 650,000-674,999 625,000-649,999 600,000-624,999 575,000-599,999 550,000-574,999 525,000-549,999 500,000-524,999 475,000-499,999 470,000-474,999 465,000-469,999 460,000-464,999 455,000-459,999 450,000-454,999 445,000-449,999 440,000-444,999 435,000-439,999 430,000-434,999 425,000-429,999 420,000-424,999 415,000-419,999 410,000-414,999 405,000-409,999 400,000-404,999 395,000-399,999 390,000-394,999 385,000-389,999 380,000-384,999 375,000-379,999 370,000-374,999 365,000-369,999 360,000-364,999 355,000-359,999 350,000-354,999 345,000-349,999 340,000-344,999 335,000-339,999 330,000-334,999 325,000-329,999 320,000-324,999 315,000-319,999 310,000-314,999 305,000-309,999 302,500-304,999 300,000-302,499 297,500-299,999 295,000-297,499 292,500-294,999 290,000-292,499 287,500-289,999 285,000-287,499 282,500-284,999 280,000-282,499 277,500-279,999 275,000-277,499 272,500-274,999 270,000-272,499 267,500-269,999 265,000-267,499 262,500-264,999 260,000-262,499 257,500-259,999 255,000-257,499 252,500-254,999 250,000-252,499 247,500-249,999 245,000-247,499 242,500-244,999 240,000-242,499 237,500-239,999 235,000-237,499 232,500-234,999 230,000-232,499 227,500-229,999 225,000-227,499 222,500-224,999 220,000-222,499 217,500-219,999 215,000-217,499 212,500-214,999 210,000-212,499 207,500-209,999 205,000-207,499 202,500-204,999 200,000-202,499 197,500-199,999 195,000-197,499 192,500-194,999 190,000-192,499 187,500-189,999 185,000-187,499 182,500-184,999 180,000-182,499 177,500-179,999 175,000-177,499 172,500-174,999 170,000-172,499 167,500-169,999 165,000-167,499 162,500-164,999 160,000-162,499 157,500-159,999 155,000-157,499 152,500-154,999 - Select - 150,000-152,499 147,500-149,999 145,000-147,499 142,500-144,999 140,000-142,499 137,500-139,999 135,000-137,499 132,500-134,999 130,000-132,499 127,500-129,999 125,000-127,499 122,500-124,999 120,000-122,499 117,500-119,999 115,000-117,499 112,500-114,999 110,000-112,499 107,500-109,999 105,000-107,499 102,500-104,999 100,000-102,499 97,500-99,999 95,000-97,499 92,500-94,999 90,000-92,499 87,500-89,999 85,000-87,499 82,500-84,999 80,000-82,499 77,500-79,999 75,000-77,499 1,000,000 + 975,000-999,999 950,000-974,999 925,000-949,999 900,000-924,999 875,000-899,999 850,000-874,999 825,000-849,999 800,000-824,999 775,000-799,999 750,000-774,999 725,000-749,999 700,000-724,999 675,000-699,999 650,000-674,999 625,000-649,999 600,000-624,999 575,000-599,999 550,000-574,999 525,000-549,999 500,000-524,999 475,000-499,999 470,000-474,999 465,000-469,999 460,000-464,999 455,000-459,999 450,000-454,999 445,000-449,999 440,000-444,999 435,000-439,999 430,000-434,999 425,000-429,999 420,000-424,999 415,000-419,999 410,000-414,999 405,000-409,999 400,000-404,999 395,000-399,999 390,000-394,999 385,000-389,999 380,000-384,999 375,000-379,999 370,000-374,999 365,000-369,999 360,000-364,999 355,000-359,999 350,000-354,999 345,000-349,999 340,000-344,999 335,000-339,999 330,000-334,999 325,000-329,999 320,000-324,999 315,000-319,999 310,000-314,999 305,000-309,999 302,500-304,999 300,000-302,499 297,500-299,999 295,000-297,499 292,500-294,999 290,000-292,499 287,500-289,999 285,000-287,499 282,500-284,999 280,000-282,499 277,500-279,999 275,000-277,499 272,500-274,999 270,000-272,499 267,500-269,999 265,000-267,499 262,500-264,999 260,000-262,499 257,500-259,999 255,000-257,499 252,500-254,999 250,000-252,499 247,500-249,999 245,000-247,499 242,500-244,999 240,000-242,499 237,500-239,999 235,000-237,499 232,500-234,999 230,000-232,499 227,500-229,999 225,000-227,499 222,500-224,999 220,000-222,499 217,500-219,999 215,000-217,499 212,500-214,999 210,000-212,499 207,500-209,999 205,000-207,499 202,500-204,999 200,000-202,499 197,500-199,999 195,000-197,499 192,500-194,999 190,000-192,499 187,500-189,999 185,000-187,499 182,500-184,999 180,000-182,499 177,500-179,999 175,000-177,499 172,500-174,999 170,000-172,499 167,500-169,999 165,000-167,499 162,500-164,999 160,000-162,499 157,500-159,999 155,000-157,499 152,500-154,999 150,000-152,499 147,500-149,999 145,000-147,499 142,500-144,999 140,000-142,499 137,500-139,999 135,000-137,499 132,500-134,999 130,000-132,499 127,500-129,999 125,000-127,499 122,500-124,999 120,000-122,499 117,500-119,999 115,000-117,499 112,500-114,999 - Select - 110,000-112,499 107,500-109,999 105,000-107,499 102,500-104,999 100,000-102,499 97,500-99,999 95,000-97,499 92,500-94,999 90,000-92,499 87,500-89,999 85,000-87,499 82,500-84,999 80,000-82,499 77,500-79,999 75,000-77,499 72,500-74,999 70,000-72,499 67,500-69,999 65,000-67,499 62,500-64,999 60,000-62,499 57,500-59,999 55,000-57,499 52,500-54,999 50,000-52,499 47,500-49,999 45,000-47,499 42,500-44,999 40,000-42,499 37,500-39,999 35,000-37,499 32,500-34,999 30,000-32,499 27,500-29,999 25,000-27,499 22,500-24,999 20,000-22,499 17,500-19,999 15,000-17,499 12,500-14,999 10,000-12,499 Paid in Full Amount Owed- 1st Mortgage 1st Mortgage- Fixed or Adjustable 1st Mortgage Interest Rate 1,000,000 + 975,000-999,999 950,000-974,999 925,000-949,999 900,000-924,999 875,000-899,999 850,000-874,999 825,000-849,999 800,000-824,999 775,000-799,999 750,000-774,999 725,000-749,999 700,000-724,999 675,000-699,999 650,000-674,999 625,000-649,999 600,000-624,999 575,000-599,999 550,000-574,999 525,000-549,999 500,000-524,999 475,000-499,999 470,000-474,999 465,000-469,999 460,000-464,999 455,000-459,999 450,000-454,999 445,000-449,999 440,000-444,999 435,000-439,999 430,000-434,999 425,000-429,999 420,000-424,999 415,000-419,999 410,000-414,999 405,000-409,999 400,000-404,999 395,000-399,999 390,000-394,999 385,000-389,999 380,000-384,999 375,000-379,999 370,000-374,999 365,000-369,999 360,000-364,999 355,000-359,999 350,000-354,999 345,000-349,999 340,000-344,999 335,000-339,999 330,000-334,999 325,000-329,999 320,000-324,999 315,000-319,999 310,000-314,999 305,000-309,999 302,500-304,999 300,000-302,499 297,500-299,999 295,000-297,499 292,500-294,999 290,000-292,499 287,500-289,999 285,000-287,499 282,500-284,999 280,000-282,499 277,500-279,999 275,000-277,499 272,500-274,999 270,000-272,499 267,500-269,999 265,000-267,499 262,500-264,999 260,000-262,499 257,500-259,999 255,000-257,499 252,500-254,999 250,000-252,499 247,500-249,999 245,000-247,499 242,500-244,999 240,000-242,499 237,500-239,999 235,000-237,499 232,500-234,999 230,000-232,499 227,500-229,999 225,000-227,499 222,500-224,999 220,000-222,499 217,500-219,999 215,000-217,499 212,500-214,999 210,000-212,499 207,500-209,999 205,000-207,499 202,500-204,999 200,000-202,499 197,500-199,999 195,000-197,499 192,500-194,999 190,000-192,499 187,500-189,999 185,000-187,499 182,500-184,999 180,000-182,499 177,500-179,999 175,000-177,499 172,500-174,999 170,000-172,499 167,500-169,999 165,000-167,499 162,500-164,999 160,000-162,499 157,500-159,999 155,000-157,499 152,500-154,999 150,000-152,499 147,500-149,999 145,000-147,499 142,500-144,999 140,000-142,499 137,500-139,999 135,000-137,499 132,500-134,999 130,000-132,499 127,500-129,999 125,000-127,499 122,500-124,999 120,000-122,499 117,500-119,999 115,000-117,499 112,500-114,999 - Select - 110,000-112,499 107,500-109,999 105,000-107,499 102,500-104,999 100,000-102,499 97,500-99,999 95,000-97,499 92,500-94,999 90,000-92,499 87,500-89,999 85,000-87,499 82,500-84,999 80,000-82,499 77,500-79,999 75,000-77,499 72,500-74,999 70,000-72,499 67,500-69,999 65,000-67,499 62,500-64,999 60,000-62,499 57,500-59,999 55,000-57,499 52,500-54,999 50,000-52,499 47,500-49,999 45,000-47,499 42,500-44,999 40,000-42,499 37,500-39,999 35,000-37,499 32,500-34,999 30,000-32,499 27,500-29,999 25,000-27,499 22,500-24,999 20,000-22,499 17,500-19,999 15,000-17,499 12,500-14,999 10,000-12,499 Paid in Full - Select - Fixed Adjustable - Select - 3% - 4% 4% - 5% 5% - 6% 6% - 7% 7% - 8% 8% - 9% 9% - 10% 10% - 11% 11% - 12% 12% - 13% 13% - 15% 16% - 18% Please Insert Comments I would like a free life insurance quote Please keep me informed of other special offers I would like to receive free mortgage updates on my mobile phone Once you have submitted this application, your information will be sent to our participating lenders. 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