Refinancing Mortgage Loans

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 fax application - fax to (800) 916 -3297

Please complete this as fully as possible then print the information and fax to us.

Type of Property  Residence   Second/Vacation      Investment


Property Address  

My primary goal is to

How much do you need to borrow 

Estimated Property Value   Original Purchase Price

Current Lender  Current balance  

Current PaymentCurrent rateMy loan is a

Yearly Tax  Yearly Insurance   Included in payment

Second Mortgage Lender Balance  

Second Payment Rate

City, State, Zip  statezip  
Time at this address?   i.e. 2.5  
Home Phone    
How to contact    
Social Security #    

Date of Birth

street & city    
Work Phone #        
Self Employed?     Yes            No         Yes            No
Time at this Job   (years) i.e. 2.5  
Gross Mo. Income   i.e. 4200  
Job Title    

Previous Employer & Residence

Complete this section if you have been at your job or your home less than 2 years

Previous Address    
City, State, Zip    
Time at address   (years) i.e 2.5  
Previous Employer    
City, State    
Time at this Job   (years) i.e. 2.5  

Credit Information


My credit history is
Co Borrower's credit is
Foreclosure if yes when
Bankruptcy if yes enter date
Has your house payment been late in the last 12 months
  >30 >60 >90
Collections, Charge offs, Judgments, Tax liens - last 24 months?
Total minimum monthly payments on credit cards and loans:

Your Comments help us understand your specific needs.

By submitting this application, I/We authorize  the verification of  business and employment status and histories and obtain a credit report.