FAST MORTGAGE APPLICATION

Mortgage Request: Home Purchase Home Re-finance Debt Consolidation Home Equity Secured Line of Credit Construction Financing

Property Description: Single Family Multi Family Condominium Townhouse Rental Property Commercial

Your Credit Profile: Excellent Good Fair Poor

Full Name:

E-mail Address:

City:

Contact Number:

Please indicate what your request is for: Home Refinance Debt Consolidation Home Equity Secured Line of Credit

Year Home Purchased: 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 Older

Estimated Home Value: $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000 $225,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $450,000 $475,000 $500,000 $525,000 $550,000 $575,000 $600,000 $625,000 $650,000 $675,000 $700,000 $725,000 $750,000 $775,000 $800,000 $825,000 $850,000 $875,000 $900,000 $925,000 $950,000 $975,000 $1,000,000 $1,025,000 $1,050,000 $1,075,000 $1,100,000 $1,125,000 $1,150,000 $1,175,000 $1,200,000 $1,225,000 $1,250,000 $1,275,000 $1,300,000 $1,325,000 $1,350,000 $1,375,000 $1,400,000 $1,425,000 $1,450,000 $1,475,000 $1,500,000 Over $1,500,000

1st Mortgage Balance: $5000 to $20000 $20000 to $40000 $40000 to $60000 $60000 to $80000 $80000 to $100000 $100000 to $120000 $120000 to $140000 $140000 to $160000 $160000 to $180000 $180000 to $200000 $200000 to $220000 $220000 to $240000 $240000 to $260000 $260000 to $280000 $280000 to $300000 $300000 to $320000 $320000 to $340000 $340000 to $360000 $360000 to $380000 $380000 to $400000 $400000 to $420000 $420000 to $440000 $440000 to $460000 $460000 to $480000 $480000 to $500000 $550000 to $600000 $600000 to $650000 $650000 to $700000 $700000 to $750000 $750000 to $800000 $800000 to $850000 $850000 to $900000 $900000 to $950000 $950000 to $1000000 Over 1,000,000

1st Mortgage Interest Rate: 2.00% 2.25% 2.50% 2.75% 3.00% 3.25% 3.50% 3.75% 4.00% 4.25% 4.50% 4.75% 5.00% 5.25% 5.50% 5.75% 6.00% 6.25% 6.50% 6.75% 7.00% 7.25% 7.50% 7.75% 8.00% 8.25% 8.50% 8.75% 9.00% 9.25% 9.50% 9.75% 10.00% Over 10%

2nd Mortgage Balance: $5000 to $20000 $20000 to $40000 $40000 to $60000 $60000 to $80000 $80000 to $100000 $100000 to $120000 $120000 to $140000 $140000 to $160000 $160000 to $180000 $180000 to $200000 $200000 to $220000 $220000 to $240000 $240000 to $260000 $260000 to $280000 $280000 to $300000 $300000 to $320000 $320000 to $340000 $340000 to $360000 $360000 to $380000 $380000 to $400000 $400000 to $420000 $420000 to $440000 $440000 to $460000 $460000 to $480000 $480000 to $500000 $500000 to $550000 $550000 to $600000 $600000 to $650000 $650000 to $700000 $700000 to $750000 $750000 to $800000 $800000 to $850000 $850000 to $900000 $900000 to $950000 $950000 to $1000000 Over 1,000,000

2nd Mortgage Interest Rate: 2.00% 2.25% 2.50% 2.75% 3.00% 3.25% 3.50% 3.75% 4.00% 4.25% 4.50% 4.75% 5.00% 5.25% 5.50% 5.75% 6.00% 6.25% 6.50% 6.75% 7.00% 7.25% 7.50% 7.75% 8.00% 8.25% 8.50% 8.75% 9.00% 9.25% 9.50% 9.75% 10.00% Over 10%

Gross Annual Income: Less than $30,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,000 $110,000 $120,000 $130,000 $140,000 $150,000 Over $150,000

Employment Status: Full Time Salary Full-Time Hourly Self-Employed Retired Not Employed

Time with Employer: Less than 1 year 1 to 2 years 3 to 5 years More than 5 years

Name of Employer:

Bankruptcy in the past 7 years: YES NO