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| Your Name (First & last) : |  | 
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| Address : |  | 
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| City : |  | 
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| State : | 
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| Zip Code : |  | 
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| Home Phone Nunber : |  | 
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| Work Phone Nunber : |  | 
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| Email Address : |  | 
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| What is your income Documentation Level : | 
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| Are You Self Employed : | Yes No | 
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| How's Your Credit : | 
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| What's Your Monthly Gross Income : |  | 
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If you're using a Co-Borrower on your loan, please answer the following questions   | 
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| Is Co-Borrower applying along with you : | Yes No | 
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| Are They Self Employed : | Yes No | 
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| How's Their Credit : | 
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| What's Their Monthly Gross Income : |  | 
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Please tell us about your refinance objectives   | 
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| Goal of Refinancing : | 
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| Are you interested in taking any cash out : | Yes No Cash Out | 
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| If so, how much : |  | 
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Please tell us about your current home and mortgage   | 
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| Property Type : | 
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| Original Home Purchase Price : |  | 
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| Date you originally purchased your home: |  
 
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| Approximate Home Value : |  | 
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| What loan type do you currently have : | 
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| What interest type is your current loan : | 
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| 1st Mortgage Balance : |  | 
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| 1st Mortgage Monthly Payment (Principal & Interest only) : |  | 
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| Do you currently have a 2nd Mortgage : | Yes No | 
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| 2nd Mortgage Balance : |  | 
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| 2nd Mortgage Interest Rate : |  | 
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| 2nd Mortgage Monthly Payment : |  | 
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| Do you currently have Mortgage Insurance (PMI) : | Yes No | 
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| Monthly Mortgage Insurance (PMI) Payment : |  | 
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Please tell us about the loan you're interested in   | 
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| Which Loan type are you interested in : | 
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| Which interest type are you interested in : | 
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| Other Information & Comments : |  | 
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