Short Application

Loan Information
How did you hear about us?
Purpose of loan: *	Purchase Refinance Construction Home Equity - LOC
Property value: *
Is there a co-borrower? *	Yes No
Type of property: *	Single Family Home Condominium Townhome Cooperative Duplex Triplex Fourplex Planned Unit Development Other
Property will be used as: *	Primary Residence Secondary Residence Investment (i.e Rental)
Property address: *
City: *
State: *	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware 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
Zip: *
Borrower Information
Existing first mortgage amount: *
Existing second mortgage amount:
First name: *
Middle name:
Last name: *
Current address:
Current city:
Current state:	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware 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
Current zip:
Contact me at: *	Home Work Cell Phone
Home phone: *
Work phone:
Cell phone:
Fax number:
Best time to call:
My credit history is:	Excellent OK, with a few problems Major credit problems Don't know
Questions or comments:
By submitting this online application I/we authorize this mortgage company to check my credit, employment history and other information stated on this application.