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1. Please tell us something about yourself:

Name   *
Property Address
State  *
Zip *
Do you live at this property? Yes  No
Work Phone *
Home Phone
Mobile Phone
email *

2. About your Work/Employment:

Can You Document Your Income?

Yes  No


Yes  No

Years on the Job or in Business 

3. About the Property: 

Approximate Value  (or Purchase Price)
Current Loan Balance *Refinance Only
Date Purchased    (mm/yy) *Refinance Only
Property Type
Number of Units

4. Loan Type:

If Purchase, Down Payment Amount?
If refi, Cash Out? Yes  No     
New Loan Amount
Loan Term
Interest Only? Yes  No    Tell Me More


5. About your Credit Rating:

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6. Comments or Questions:

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