Please provide us with as much information as possible, so that we may process your application request accurately and completely. All required information is noted with a: ^†

E-mail Address†
Name†
Social Security Number
Address†
City, State, Zip†	, AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY ,
Home Phone†
Work Phone†
Best Time To Call
Employer†
Years Employed†
Monthly Income†
Name
Social Security Number
Employer Name
Years Employed
Monthly Income
Type of Property†	-- Choose One -- Single Family Condominium Units
Balance on Existing Mortgage†
Current Monthly Payment†
Current Interest Rate†	Fixed Adjustable
Estimated Value of Home†
Loan Amount†
Loan Type	-- Choose One -- Lower Your Current Rate Cash Out - Debt Consolidation Home Improvement Tough Credit - New Start Program Home Purchase
Down Payment  (Purchases Only)	3% Down 5% Down 10% Down 15% Down 20%+ Minimum 3% Down  Gifts OK / Grants Available
Loan term	-- Choose One -- 30 Yr. 20 Yr. 15 Yr. 10 Yr. adjustable
How would you rate your credit?	-- Choose One -- Good Fair Poor
Are you a home owner?†	No Yes
How long have you owned your home	-- Choose One -- less than 1 year 1 - 3 years 4 - 5 years 5 - 10 years 11 - 14 years 15 or more years
When would you like your loan to close?	2 weeks 3 weeks 4 weeks
Previous Bankruptcy?	Never Chapter 7 Chapter 13
How did you find us?	Internet Referral Newspaper TV American Loan Search
(If Referred) By Who?
Are you working with another lender?	No Yes
Which best fits your situation.	-- Choose One -- I want to pre-qualify for a home purchase. I have a purchase contract and need financing. I want to refinance to consolidate my bills I want to refinance to lower my interest rate.
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