Request Form

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State you are Refinancing in: Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia 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 *

County where your home is located: *

Approximate CURRENT value of home to be refinanced: Select... Please Select... under $50,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $210,000 $220,000 $230,000 $240,000 $250,000 $260,000 $270,000 $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 $340,000 $350,000 $360,000 $370,000 $380,000 $390,000 $400,000 over $400,000 *

How much do you currently owe on your home? Select... Please Select... under $50,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 $160,000 $170,000 $180,000 $190,000 $200,000 $210,000 $220,000 $230,000 $240,000 $250,000 $260,000 $270,000 $280,000 $290,000 $300,000 $310,000 $320,000 $330,000 $340,000 $350,000 $360,000 $370,000 $380,000 $390,000 $400,000 over $400,000 *

What is your current Interest Rate? *

Is your current home loan a VA Home Loan? Yes No

Why are you looking to refinance? Select.. Refinance to a Lower Rate Pay Off Debt Cashout Home Improvement Other

When are you looking to refinance? Select... Immediately Within a month in 2-6 months over 6 months

Rate Your Credit: Select... Excellent: Credit Score over 780 Good: Credit Score 680-780 Fair: Credit Score 580-680 Poor: Credit Score Below 580 *

*** if you don't know your credit score, get it now at www.annualcreditreport.com

What is your total monthly income? *

Have you filed for bankruptcy? Select... Within the Last 12 Months 1-2 years ago Over 2 years ago *

Have you filed for or ever had a foreclosure? Select... Within the Last 12 Months 1-2 years ago Over 2 years ago *

Have you been late on mortgage payments in the last 12 months? Yes No

What is your total MINIMUM payments per month for credit cards? *

Have you been late on credit card payments in the last 12 months? Yes No

What is your total payments per month for car loans? *

What is your total payments per month for student loans? *

Do you have over $ 5,000 in collections? In other words, do you have $ 5,000 owed that debt collectors are calling you on? Yes No

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First Name: *

Last Name: *

Phone #: *

Email: *

How did you hear about us?

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