What type of residence will you be selling: My primary residence My 2nd home or vacation home An investment property

The home I'd like to purchase is:
Single Family Townhome Condominium Co-op Multi-family Mobile home  

I currently have the following type of federal loan:
None VA Loan FHA Loan  

I currently qualify for the following type of federal loan:
None VA Loan FHA Loan  

Are you interested in a no-document loan?
No Yes  

I would like to find this loan in the next:
30 days 60 days 90 days or more I'm still shopping loans  

What term loan do you want:
15 years 30 years  

Your current mortgage monthly payment:
$

Current mortgage interest rate:
%

Do you need any cash back?
$

How much is your current home  worth:
$

Your home's original sale price:
$

How long have you owned your home:
 years

Your current mortgage balance:
$

Do you have a 2nd home loan?
No Yes  

2nd mortgage balance:
$

2nd mortgage monthly payment:
$

2nd mortgage interest rate:
%

What are you planning to pay for your new home:
$

How much money do you want to put down on your new home:
$

Are you self-employed?
No Yes  

If no, how long have you been with your employer:
 years

What type of loan do you want?
Adjustable Fixed  

How is your credit?
Excellent Good Fair Poor  

How much do you gross each month:
$

How much do you owe each month:
$

E-mail Address:
 

Best time for a licensed professional to call?
8 - 10 a.m 10 a.m - 12 p.m 12 - 2 p.m 2 - 4 p.m 4 - 6 p.m After 6 p.m Weekends  

First Name:
 

Have you thought of selling your home?
No Yes  

Last Name:
 

If yes, what is your time frame for selling?
1 Month 3 Months 6 Months 1 Year  

Address Line 1:
 

Would you like a real estate broker to call you and explain your options?
No Yes  

Address Line 2: (Apt. #, Suite #, etc.)
 

Would you like an additional quote for any of the following Insurance products?

 Life Insurance
 Annuity (Retirement Vehicle)
 Long Term Care Insurance
 Disability Income Insurance
 Health Insurance
 Group Health Insurance
 Homeowners Insurance
 Auto Insurance

City:
 

State:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming  

Zip Code:
 

Day Phone:
    

Eve Phone: