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First Name* Last Name* Street Address*    City* State* -- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VA VT WA WV WI WY Zip* (Please enter location of actual property)		Work Phone ( ) - ext. Home Phone* ( ) - Email Address* (double check for accuracy) (ex, john@yahoo.com)
Enter Mortgage Information
Select Type of Loan Requested* Refinance Mortgage New Home Purchase Debt Consolidation Home Equity  Loan Second Mortgage Debt Consolidation Home Improvement Loan 125% Loan Construction Loan FHA/VA All Loans available with Fixed or Adjustable rate terms!		Loan Amount Requested* - Please Select One - $20,000 to $30,000 $30,000 to $40,000 $40,000 to $50,000 $50,000 to $60,000 $60,000 to $70,000 $70,000 to $80,000 $80,000 to $90,000 $90,000 to $100,000 $100,000 to $110,000 $110,000 to $120,000 $120,000 to $130,000 $130,000 to $140,000 $140,000 to $150,000 $150,000 to $160,000 $160,000 to $170,000 $170,000 to $180,000 $180,000 to $190,000 $190,000 to $200,000 $200,000 to $210,000 $210,000 to $220,000 $220,000 to $230,000 $230,000 to $240,000 $240,000 to $250,000 $250,000 to $260,000 $260,000 to $270,000 $270,000 to $280,000 $280,000 to $290,000 $290,000 to $300,000 $300,000 to $310,000 $310,000 to $320,000 $320,000 to $330,000 $330,000 to $340,000 $340,000 to $350,000 $350,000 to $360,000 $360,000 to $370,000 $370,000 to $380,000 $380,000 to $390,000 $390,000 to $400,000 $400,000 to $410,000 $410,000 to $420,000 $420,000 to $430,000 $430,000 to $440,000 $440,000 to $450,000 $450,000 to $460,000 $460,000 to $470,000 $470,000 to $480,000 $480,000 to $490,000 $490,000 to $500,000 $500,000 to $510,000 $510,000 to $520,000 $520,000 to $530,000 $530,000 to $540,000 $540,000 to $550,000 $550,000 to $560,000 $560,000 to $570,000 $570,000 to $580,000 $580,000 to $590,000 $590,000 to $600,000 $600,000 to $610,000 $610,000 to $620,000 $620,000 to $630,000 $630,000 to $640,000 $640,000 to $650,000 $650,000 to $660,000 $660,000 to $670,000 $670,000 to $680,000 $680,000 to $690,000 $690,000 to $700,000 $700,000 to $710,000 $710,000 to $720,000 $720,000 to $730,000 $730,000 to $740,000 $740,000 to $750,000 $750,000 to $760,000 $760,000 to $770,000 $770,000 to $780,000 $780,000 to $790,000 $790,000 to $800,000 $800,000 to $810,000 $810,000 to $820,000 $820,000 to $830,000 $830,000 to $840,000 $840,000 to $850,000 $850,000 to $860,000 $860,000 to $870,000 $870,000 to $880,000 $880,000 to $890,000 $890,000 to $900,000 $900,000 to $910,000 $910,000 to $920,000 $920,000 to $930,000 $930,000 to $940,000 $940,000 to $950,000 $950,000 to $960,000 $960,000 to $970,000 $970,000 to $980,000 $980,000 to $990,000 $990,000 to $1,000,000 $1,000,000+ ($20,000 Minimum)
		Property Type* - Please Select One - Single-Family Detached Townhouse Condominium Cooperative Multi-Family Dwelling Modular (NO Mobile Homes)
		1st Mortgage Balance* (Amount Owed)
		Property Value* (Less than 75000 not accepted)
		Current Interest Rate* 14 - 14.24 13.75 - 13.99 13.5 - 13.74 13.25 - 13.49 13 - 13.24 12.75 - 12.99 12.5 - 12.74 12.25 - 12.49 12 - 12.24 11.75 - 11.99 11.5 - 11.74 11.25 - 11.49 11 - 11.24 10.75 - 10.99 10.5 - 10.74 10.25 - 10.49 10 - 10.24 9.75 - 9.99 9.5 - 9.74 9.25 - 9.49 9 - 9.24 8.75 - 8.99 8.5 - 8.74 8.25 - 8.49 8 - 8.24 7.75 - 7.99 7.5 - 7.74 7.25 - 7.49 Select: 7 - 7.24 6.75 - 6.99 6.5 - 6.74 6.25 - 6.49 6 - 6.24 5.75 - 5.99 5.5 - 5.74 5.25 - 5.49 5 - 5.24 4.75 - 4.99 4.5 - 4.74 4.25 - 4.49 4 - 4.24 3.75 - 3.99 3.5 - 3.74 3.25 - 3.49 3 - 3.24 N/A
		Select: No Yes I need the loan in 30 days or less.*
		Select: No Yes Declared bankruptcy in the past 12 months?
		Select: No Yes Property Currently under foreclosure
		Best Time To Contact* Select: Early Morning Mid Morning Noon Afternoon Evening
		Rate Your Credit* - Please Select One - Excellent Good Fair Poor
		Currently Employed? - Please Select One - 1-3 Years 4-7 Years 7-10 Years 10+ Years Not Employed
I, understand that by clicking the "Match Me with Qualified Lenders!" button and authorizing this submission, I am not obligated to open an account. (This prequalification request is not a loan application. Your loan officer will complete a loan application for you.)

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