Refinance Application

The following form provides the information needed to help us analyze your mortgage options and recommend the best programs and lowest rates for you.  Simply complete the form to the best of your ability and one of our licensed mortgage consultants will contact you.  We normally will be in touch within 24 hours, excluding holidays.  All information is private and secure.
This form should take around five minutes to complete.
 Loan Information
* required field 
         * Loan Purpose:

* What type of mortgage do you want (including FHA loans)? 
(Select up to 3):

Fixed Rate:
10 year 15 year
20 year 25 year
30 year 40 year
Adjustable Rate:
3/1 ARM 5/1 ARM
7/1 ARM 10/1 ARM
Other products including Interest Only
Estimated Home Value:

         * Loan Amount:



Personal Information


 Request Borrower Co-Borrower
* First Name:
Middle Initial:
* Last Name:
* Address:
* Address 2:
* City:
* County:
* State:
* Zip:
* Home Phone:
Work Phone:
Cell Phone:
* Best Time to contact:
* Email Address:
* Social Security #:
* Monthly Income:
  Notice: Alimony, child support, or separate maintenance income need not be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan.  If you would prefer a low doc program - enter "stated" for the income amount.
Self Employed:
Years employed at current job:
Years employed in current line of work/profession
* Date of Birth:  
ex. 10/09/63
ex. 10/09/63


Credit Information


Request Borrower Co-Borrower
* How is your credit? 
    (click here for help)
* Ever filed for bankruptcy?


Property Information


Complete for the property you are refinancing.
Street Address:
Zip Code:
* Month/Year
*Purchase Price $
* Type of Property:  
Yearly Taxes: $ Yearly Insurance: $


Existing Mortgage Information


 Mortgage Company Balance Rate Payment
First: $ $
Second: $ $
Equity Line: $ $
Are Taxes & Insurance Escrowed?


HMDA & Equal Credit Opportunity Disclosures

The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the lender's compliance with Equal Credit Opportunity, Fair Housing, and Home Mortgage Disclosure (HMDA) laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. Lender must review the material to assure that the disclosure satisfies all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.

Race/National Origin: I do not wish to provide this information Race/National Origin: I do not wish to provide this information
  American Indian or Alaskan Native   American Indian or Alaskan Native
  Black, not of Hispanic origin   Black, not of Hispanic origin
  Hispanic   Hispanic
  White, not of Hispanic Origin   White, not of Hispanic Origin
Sex: Male    Female Sex: Male    Female


Question Borrower Co-Borrower

Are there any outstanding judgments against you?

Yes    No

Yes    No
Have you been declared bankrupt within the past 7 years?
Yes    No Yes    No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Yes    No Yes    No
Are you a party to a lawsuit?
Yes    No Yes    No
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?
Yes    No Yes    No
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Yes    No Yes    No
Are you obligated to pay alimony, child support, or separate maintenance?
Yes    No Yes    No
Are you a co-maker or endorser on a note?
Yes    No Yes    No
Are you a U.S. citizen?
Yes    No Yes    No
Are you a permanent resident alien?
Yes    No Yes    No
Do you intend to occupy the property as your primary residence?
Yes    No Yes    No
Have you had an ownership interest in a property in the last three years?
Yes    No Yes    No
What type of property did you own?
How did you hold title?
I authorize to obtain information regarding my credit, employment history, income and assets. In addition, I authorize to obtain my credit report and information concerning any property that may secure my loan.

I authorize to provide documents and disclosures electronically and have the ability to do so, as described in consent for electronic disclosures.
Include any additional information that may be helpful, 
including if you have previously spoken to a loan specialist.

One last question if we may - 
where did you hear of   

        You may experience a slight delay after sending, as the data is transmitted to our secure server.