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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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