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01/110911

TYPE OF LOAN

1

Purchase
1

Refinance

02/110911

PROPERTY USE

1

Primary
1

SECONDARY
1

RENTAL
PROPERTY

04/110911

TYPE OF PROPERTY

1

Single
Family
1

Condo
1

MULTI-FAMILY
1

TOWNHOME

LOAN AMOUNT

$

$0
$1,000,000+

TYPE OF PROPERTY

1

Single
Family
1

Condo
1

MULTI-FAMILY
1

TOWNHOME

05/110911

ESTIMATED PURCHASE PRICE

$

$0
$1,000,000+

ESTIMATED VALUE

$

$0
$1,000,000+

ESTIMATED CONSTRUCTION COST

$

$0
$1,000,000+

06/110911

ESTIMATED DOWN PAYMENT

1

0%
1

3.5%
1

5%
1

10%
1

20% or >

Property Location

CITY

ZIP

DESIRED AMOUNT TO BORROW

$

$0
$1,000,000+

07/110911

Property Location

City

Zip

ESTIMATED CREDIT

1

Excellent
1

Good
1

Fair
1

Poor

Property Location

City

State

Zip

08/110911

WORKING WITH A REAL ESTATE AGENT?

1

Yes
1

No

Do you have a co-borrower

1

Yes
1

No

First Name

Last Name

Phone

Email

WORKING WITH A BUILDER?

1

Yes
1

No

09/110911

ESTIMATED CREDIT

1

Excellent
1

Good
1

Fair
1

Poor

Contact Info

First Name

Last Name

Phone

Email

ESTIMATED CREDIT

1

Excellent
1

Good
1

Fair
1

Poor

10/110811

Do you have a co-borrower

1

Yes
1

No

First Name

Last Name

Phone

Email

WORKING WITH LOAN OFFICER

1

Yes
1

No

Enter Loan Originator Name

11/110811

CONTACT INFO

First Name

Last Name

Phone

Email