Loan officer:

Choose an option... Jon Stewart Jerry Butts Fred Dambrie Dave Leonard Allyson Carter *

Your Name:

*

Street Address:

*

Mailing Address (if different):

City:

State:

Zip Code:

Home Phone:

*

Work Phone:

*

Best Time to Call:

Choose an option... Contact me now... Contact me during the day Contact me in the evening *

Email Address:

*

Do You Have A Realtor:

Choose an option... Yes No *

Realtor's Name:

*

Realtor's Agency:

Realtor's Phone Number:

*

New Property & Loan Information

Property Location:

Choose an option... Connecticut Maine Massachusetts New Hampshire New York Other *

Property Type:

Choose an option... Single Family Two Family Three Family Four Family *

Loan Purpose:

Choose an option... Purchase Purchase (pre-approval) Refinance Debt Consolidation Equity Line of Credit *

Preferred Loan Type:

Choose an option... Fixed Rate (30 yr) Fixed Rate (20yr) Fixed Rate (15yr) Fixed Rate (10yr) 1 yr. Adjustable 3/1 Adjustable 3/3 Adjustable 5/1 Adjustable 7/1 Adjustable 10/1 Adjustable *

Desired Loan Amount:

*

Sales Price, or if refinancing, Value of Home:

*

If purchasing, what is the closing date:

Current Information

Annual Household Income:

*

Monthly Consumer Debt:

*

Current Mortgage Balance:

*

Current Rate (if refinancing):

If refinancing, do you currently have an equity loan too:

Choose an option... Yes No *

*

Have you ever declared Bankruptcy:

Choose an option... Yes No *

*

Rate your Credit:

Choose an option... Excellent Good Fair Poor Currently in Bankruptcy *

Credit Report

Permission to pull credit report:

Choose an option... Yes No *

*

*

*

Comments and Questions