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Your Full Name *
Address *
City *
State(USA Only) AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY * UNITED STATES ONLY!
Zip/Postal Code *
Home Phone *
Work Phone *
Email Address *
Best Time To Call Morning at Home Morning at Work Afternoon at Home Afternoon at Work Evening at Home Late Evening at Home *
Do You Own Your Home? Yes No * Mobile Homes Do Not Qualify
Property Value = 50000)) { alert('Not Valid! Please enter the approximate value of current property or property you wish to purchase \n (greater than or equal to 50000) using only number characters - 0123456789'); this.focus(); this.select(); return false; }"> * Please use numbers only
Property Type Single Family Residence Condo Townhouse 2-4 Plex Other *
Purchase Price * Please use numbers only

Year Acquired

*
1st Mortgage-Balance Owed * Please use numbers only (ex:45000) enter 0 for none
1st Mortgage-Interest Rate 10 or above Below 7.0 7.1 - 7.49 7.5 - 7.998.0 - 8.49 8.5 - 8.99 9.0 - 9.49 9.5 - 9.99 None %
Is 1st Adjustable or Fixed? Fixed Adjustable *
Employer *
Monthly Gross Household Income * Please use numbers only
2nd Mortgage Balance owed > * Please use numbers only(ex:45000) enter 0 for none
Amount You Wish To Borrow 15,000 - 30,000 30,000 - 45,000 45,000 - 60,000 60,000 - 75,000 75,000 - 90,000 90,000 - 110,000 110,000 - 125,000 125,000 & Up *
Credit Rating Good Fair Poor Excellent *
Monthly Debt * Please use numbers only
Loan Interested In Debt Consolidation Second Mortgage Home Improvement Refinance Purchase *
 

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