Easy Loan Application

Borrower:
E-mail:
Address:
City:
State:	-- Select One -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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:
Home #:	( )- ext.
Work #:	( )- ext.
Cell #:	( )-
Fax #:	( )-
Preferred Number:	-- Select One -- Home Number Work Number Cell Number Fax Number

:: SUBJECT PROPERTY ::
Real Estate to be used as collateral for this loan:
Type: -- Select One -- Condominium Townhouse Home Residential Multi-Family Commercial Industrial Land Other Address: City: State: -- Select One -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware 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:
Property Description:
Year Purchased:	-- Select One -- To Be Purchased 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Prior to 1980
Purchase Price :
Will subject property be owner occupied?	Yes No
Estimated value of subject property:
per recent appraisal?	Yes No
1st Loan Balance:
Lender:
Monthly Payment:
Payments Current?	Yes No
2nd Loan Balance:
If Credit Line, Max Limit =
Lender:
Monthly Payment:
Payments Current?	Yes No
Are Property Taxes Current?	Yes No
Is there a Homeowner's Assn.?	Yes No
Are Assn. Dues Current?	Yes No NA
Is Fire Insurance Current?	Yes No

:: LOAN REQUEST ::
New Loan Request:
New Loan Position:	-- Select One -- No Senior Loans Behind 1 Senior Loan Behind 2 Senior Loans
Purpose of Loan:
Comments/Questions/Suggestions:
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