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Property Information Property type:   Select one...Single Family Residence (SFR)Multi Family Residential 2-4 UnitsMulti Family Residential 5+ UnitsCommercialVacant land (land only, no construction)Vacant Land with Construction combined - ResidentialVacant Land with Construction combined - CommercialBoatCondominiumApartment building 40+Hotel/MotelChurchStrip mallMobile/Manufactured Home - on leased landMobile Home - with land ownershipManufactured Home - with land ownershipRV parkRural commercialRanch/farmGas stationOther CommercialOther Residential Zip/Postal code:   Property address:   (If no address, write UNKNOWN or CONFIDENTIAL) City:   Country:   --Select One--USA---------------------AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBhutanBosnia And HerzegowinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And The South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province Of ChinaTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUSAUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZaireZambia Property estimated value: $ Select one...$60,000$70,000$80,000$90,000$100,000$110,000$120,000$130,000$140,000$150,000$160,000$170,000$180,000$190,000$200,000$210,000$220,000$230,000$240,000$250,000$260,000$270,000$280,000$290,000$300,000$310,000$320,000$330,000$340,000$350,000$360,000$370,000$380,000$390,000$400,000$410,000$420,000$430,000$440,000$450,000$460,000$470,000$480,000$490,000$500,000$510,000$520,000$530,000$540,000$550,000$560,000$570,000$580,000$590,000$600,000$610,000$620,000$630,000$640,000$650,000$660,000$670,000$680,000$690,000$700,000$710,000$720,000$730,000$740,000$750,000$760,000$770,000$780,000$790,000$800,000$810,000$820,000$830,000$840,000$850,000$860,000$870,000$880,000$890,000$900,000$910,000$920,000$930,000$940,000$950,000$960,000$970,000$980,000$990,000$1,000,000$1,100,000$1,200,000$1,300,000$1,400,000$1,500,000$1,600,000$1,700,000$1,800,000$1,900,000$2,000,000$2,100,000$2,200,000$2,300,000$2,400,000$2,500,000$2,600,000$2,700,000$2,800,000$2,900,000$3,000,000 or enter value here Loan Information Loan request: (min $10,000.00) $ Select one...$30,000$40,000$50,000$60,000$70,000$80,000$90,000$100,000$110,000$120,000$130,000$140,000$150,000$160,000$170,000$180,000$190,000$200,000$210,000$220,000$230,000$240,000$250,000$260,000$270,000$280,000$290,000$300,000$310,000$320,000$330,000$340,000$350,000$360,000$370,000$380,000$390,000$400,000$410,000$420,000$430,000$440,000$450,000$460,000$470,000$480,000$490,000$500,000$510,000$520,000$530,000$540,000$550,000$560,000$570,000$580,000$590,000$600,000$610,000$620,000$630,000$640,000$650,000$660,000$670,000$680,000$690,000$700,000$710,000$720,000$730,000$740,000$750,000$760,000$770,000$780,000$790,000$800,000$810,000$820,000$830,000$840,000$850,000$860,000$870,000$880,000$890,000$900,000$910,000$920,000$930,000$940,000$950,000$960,000$970,000$980,000$990,000$1,000,000$1,100,000$1,200,000$1,300,000$1,400,000$1,500,000$1,600,000$1,700,000$1,800,000$1,900,000$2,000,000$2,100,000$2,200,000$2,300,000$2,400,000$2,500,000$2,600,000$2,700,000$2,800,000$2,900,000$3,000,000 or enter value here   Nature of transaction:   Select one...Property PurchaseRefinance (with or without cash out)- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Loan Not Secured By Real Estate Loan purpose:   Select one...Construction/Major RemodelingFirst MortgageSecond Mortgage onlyHome Equity Line of Credit (HELOC)First+ Second (or+ HELOC)Reverse MortgageBusiness Loan Secured By Real EstateOther Real Estate Loan- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - BoatPersonal loanCar or Motorcycle LoanCredit cardStudent loanBusiness loan (Without real estate)Other - Something else Owner Occupancy:   Owner occupied Non Owner Amount of Existing Loans:   Select one...$0 (no loans)$10,000$20,000$30,000$40,000$50,000$60,000$70,000$80,000$90,000$100,000$110,000$120,000$130,000$140,000$150,000$160,000$170,000$180,000$190,000$200,000$210,000$220,000$230,000$240,000$250,000$260,000$270,000$280,000$290,000$300,000$310,000$320,000$330,000$340,000$350,000$360,000$370,000$380,000$390,000$400,000$410,000$420,000$430,000$440,000$450,000$460,000$470,000$480,000$490,000$500,000$510,000$520,000$530,000$540,000$550,000$560,000$570,000$580,000$590,000$600,000$610,000$620,000$630,000$640,000$650,000$660,000$670,000$680,000$690,000$700,000$710,000$720,000$730,000$740,000$750,000$760,000$770,000$780,000$790,000$800,000$810,000$820,000$830,000$840,000$850,000$860,000$870,000$880,000$890,000$900,000$910,000$920,000$930,000$940,000$950,000$960,000$970,000$980,000$990,000$1,000,000$1,100,000$1,200,000$1,300,000$1,400,000$1,500,000$1,600,000$1,700,000$1,800,000$1,900,000$2,000,000$2,100,000$2,200,000$2,300,000$2,400,000$2,500,000$2,600,000$2,700,000$2,800,000$2,900,000$3,000,000 or enter value here Borrower Information Annual income:   Select one...$0 - $20,000$20,000 - $30,000$30,000 - $40,000$40,000 - $50,000$50,000 - $60,000$60,000 - $70,000$70,000 - $100,000$100,000 - $130,000$130,000 - $200,000$200,000 - $500,000$500,000+Unavailable for disclosure   I can verify my income       I cannot verify my income Select your credit rating:   AAA Superior 740+AA Excellent 720-739A+ Very Good 700-719A Good 680-699A- Fine 660-679B+ OK Credit 640-659B Fair 620-639C Below Fair 600-619C- Inferior 580-599D Bad 520-579F Very bad 519 Net Worth (Estimated): $ Select one...$2,000 - $5,000$5,000 - $20,000$20,000 - $40,000$40,000 - $70,000$70,000 - $100,000$100,000 - $150,000$150,000 - $250,000$250,000 - $500,000$500,000 - $1,000,000$1,000,000 - $4,000,000$4,000,000 - $10,000,000Over $10,000,000Unavailable for disclosure

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