Mortgage Refinance Application

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First Name
Last Name
E-Mail
Property Address
City
State, ZIP Code		Select 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 ,
Social Security Number
Time at Current Job		Select 6 months or less 6-12 months 1-2 years Over 2 years Retired
Self-Employed		Yes No
Work Phone
Home Phone
Additional Cash Desired		Select None $20,000 or less $20,001 – 45,000 $45,001 – 65,000 $65,001 – 85,000 $85,001 – 100,000 $100,001 – 150,000 Over $150,000
Purchase Date		Select January February March April May June July August September October November December Select 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 Before 1985
Home Type		Select Primary - Single Family Primary - Condo Primary - Mobile Home Primary - Townhome Primary - Multiple Family Dwelling 2nd Home - Condo 2nd Home - Mobile Home 2nd Home/Vacation - Single Family 2nd Home - Townhome 2nd Home - Multiple Family Dwelling Investment - Condo Investment - Mobile Home Investment - Townhome Investment - Multiple Family Dwelling
Current Property Value		Select $50,000 or less $50,001 - 75,000 $75,001 - 100,000 $100,001 - 125,000 $125,001 - 150,000 $150,001 - 175,000 $175,001 - 200,000 $200,001 - 250,000 $250,001 - 300,000 $300,001 - 350,000 $350,001 - 400,000 $400,001 - 450,000 $450,001 - 500,000 $500,001 - 600,000 $600,001 - 700,000 $700,001 - 800,000 $800,001 - 900,000 $900,001 - 1,000,000 Over $1,000,000
First Mortgage Balance		Select $50,000 or less $50,001 - 75,000 $75,001 - 100,000 $100,001 - 125,000 $125,001 - 150,000 $150,001 - 175,000 $175,001 - 200,000 $200,001 - 250,000 $250,001 - 300,000 $300,001 - 350,000 $350,001 - 400,000 $400,001 - 450,000 $450,001 - 500,000 $500,001 - 600,000 $600,001 - 700,000 $700,001 - 800,000 $800,001 - 900,000 $900,001 - 1,000,000 Over $1,000,000
First Mortgage Monthly Payment		Select $400 or less $401 - 500 $501 - 600 $601 - 700 $701 - 800 $801 - 900 $901 - 1,000 $1,001 - 1,250 $1,251 - 1,500 $1,501 - 1,750 $1,751 - 2,000 $2,001 - 2,500 $2,501 - 3,000 $3,001 - 4,000 $4,001 - 5,000 $5,001 - 6,000 $6,001 - 7,000 Over $7,000
Current Interest Rate		Select (pick closest value) 3.0 % or less 3.5 % 4.0 % 4.5 % 5.0 % 5.5 % 6.0 % 6.5 % 7.0 % 7.5 % 8.0 % 8.5 % 9.0 % 9.5 % 10.0 % 11.0 % 12.0 % Over 12.0 %
Current Mortgage Term		Select 30 Year Fixed 30 Year Adjustable 15 Year Fixed 15 Year Adjustable Other
Do you have a second mortgage?		Yes   No
Annual Household Gross Income		Select $30,000 or less $30,001 - 45,000 $45,001 - 60,000 $60,001 - 75,000 $75,001 - 90,000 $90,001 - 105,000 $105,001 - 120,000 Over $120,000
Estimated Credit History		Select Excellent Good Fair Poor
Recent Foreclosure or Bankruptcy		Select No 1 Year Ago 2 Years Ago 3 Years Ago 4 Years Ago 5 Years Ago 6 Years Ago 7 Years Ago