This Express Application puts you directly in touch with a loan officer. Simply complete the information below and a loan officer will contact you.

Borrower: First Name:

Last Name:

Co-Borrower: First Name:

Last Name:

Address:

City:

State:

Zip Code:

Phone:(Day)(Area Code + Number):

EXT:

Phone:(Evening)(Area Code + Number):

EXT:

E-Mail Address:

Morning Afternoon Evening

Best Time to Call:

Type of Loan Requested:

FHA Refinance

VA Refinance

Conventional Refinance

Cash Out Refinance

Second Mortgage Debt Consolidation

Second Mortgage Home Improvement

125% Second Mortgage

Construction/Permenant Loan

Name of Current Lender

Account Number with them

Present Monthly Mortgage Payment (Principal, Interest, Taxes, & Insurance):

$

Present Loan Balance:

$

Current Property Value:

$

Current Loan Type:(FHA,VA,Conventional)

Fixed or Adjustable Rate:

Current Interest Rate:

%

Household Employment Income:

Weekly Monthly Annual

Gross Paycheck(s):  $

Self Employment Income (if applicable):    $

Last Year's Income from Tax Return Schedule C (line 29): $

Previous Year's Income from Tax Return Schedule C (line 29): $

Other regular sources of income (pensions, disability, alimony, child support):          $

Yes No

Can you document your income through Paystubs, W2's, etc.?

Have you been steadily employed in the same line of work for over two years?

Yes No

Please list the following total monthly obligations (Credit Cards & Installment Debts.):                   $

Excellent Good Fair Poor

How would you rate your credit:

Property Type:

Single Family House Duplex Condominium

Would  you like us to obtain your credit grade prior to returning your call?

Yes No

If yes, please supply the following:

Borrowers Social Security Number:

Co-Borrowers Social Security Number:

To Our Front Page

Would You Like to know more about us?