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Purpose: Select One Refinance for Lower Rate Refinance for Debt Consolidation Refinance for Home Improvement Refinance for Cash-Out Purchase New Home Home Equity Loan/2nd Mortgage	Your Mortgage Balance: $
	Value of Property: $
Type of Home: Select One Single Family Condo Townhouse 2-4 Plex Other	Additional Cash Needed?: $
Your Credit Rating: Select One Excellent, Never any issues Good, No recent issues Fair, Recent issues Poor, Major issues	Current Interest Rate:   19.75 - 19.99 19.5 - 19.74 19.25 - 19.49 19 - 19.24 18.75 - 18.99 18.5 - 18.74 18.25 - 18.49 18 - 18.24 17.75 - 17.99 17.5 - 17.74 17.25 - 17.49 17 - 17.24 16.75 - 16.99 16.5 - 16.74 16.25 - 16.49 16 - 16.24 15.75 - 15.99 15.5 - 15.74 15.25 - 15.49 15 - 15.24 14.75 - 14.99 14.5 - 14.74 14.25 - 14.49 14 - 14.24 13.75 - 13.99 13.5 - 13.74 13.25 - 13.49 13 - 13.24 12.75 - 12.99 12.5 - 12.74 12.25 - 12.49 12 - 12.24 11.75 - 11.99 11.5 - 11.74 11.25 - 11.49 11 - 11.24 10.75 - 10.99 10.5 - 10.74 10.25 - 10.49 10 - 10.24 9.75 - 9.99 9.5 - 9.74 9.25 - 9.49 9 - 9.24 8.75 - 8.99 8.5 - 8.74 8.25 - 8.49 8 - 8.24 7.75 - 7.99 7.5 - 7.74 7.25 - 7.49 7 - 7.24 6.75 - 6.99 Select One 6.5 - 6.74 6.25 - 6.49 6 - 6.24 5.75 - 5.99 5.5 - 5.74 5.25 - 5.49 5 - 5.24 4.75 - 4.99 4.5 - 4.74 4.25 - 4.49 4 - 4.24 3.75 - 3.99 3.5 - 3.74 3.25 - 3.49 3 - 3.24 %   Select one Fixed Adjustable Not Sure
First Name: Last Name: Address: City: State: Select State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code: Home Phone: Work/Cell Phone: Ext Email Address: Best Contact Time: Select One Morning at Home Morning at Work Afternoon at Home Afternoon at Work Evening at Home Late Evening at Home