REQUEST FOR LOAN COMPARISON OR RATE QUOTE
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Please fill out as much information as you can, so that we may give you as complete a loan comparison as possible.
First Name:
Last Name:
Street Address:
City:
State:
Property Location (State Only):
Zip:
Home Phone:
Work Phone:
Cell Phone:
E-Mail Address:
Loan Purpose: (Choose One)	Purchase: Refinance: Cashout Refinance
Property Type: (Choose One)	Primary Residence: Second Home (Vacation) Investment Property
If this is a purchase, have you identified the property?	Yes No
If you have NOT identified the property, when are you looking to move?
Loan Amount:
Property Value or Purchase Price:
Mortgage Balance
Can You show Income?	Yes No
Can You show Assets?	Yes No
Loan Type: Check All Loans You Are Interested In	30 Yr Fixed 15 Yr Fixed 30 Year Fixed Interest Only (with 10 or 15 year interest only period) Interest Only Option Arms: COFI MTA CODI COSI LIBOR Libor Arms: 1 Month 6 Month 1 Yr 3 Yr 5 Yr 7 Yr 10 Yr Arm w/Interest Only Reverse Mortgage Other (Please Describe)
Credit Type (Choose One)	Excellent Good Fair Poor
Self-Employed ( If Yes, Length of Time)
Bankruptcy (If Yes, How Long Ago)
Comments:
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