Contact Information Collection Form

1

NamePlease insert the First and Last name of the client.

First Name

Last Name

2

E-mail

3

Phone NumberPlease enter an active telephone number.

Area Code

Phone Number

4

Loan Amount (USD)Please answer the best you can for better results.

5

Value of the Property (USD)Please answer the best you can for better results.

6

FICO Credit Score (300-800)Please answer the best you can for better results.

7

Loan TypePlease answer the best you can for better results.

30 Year Fixed

5/1 ARM (fixed for 5 years with a lower rate)

I don't know or I'm not sure

8

Loan PurposePlease answer the best you can for better results.

Refinance

Refinance Cash out

Purchase

9

Property TypePlease answer the best you can for better results.

Owner Occupied

2nd Home

Non-Owner Occupied

10

What Income Documentation can you provide?We need this information to see if you qualify for a loan. We accept all levels of documentation available.

Tax returns

12 Months of Bank Statements

I have none of these two Income Documentation available

11

What is your status?

Foreign National

U.S. Citizen

12

Brief Description of Request:Please add below any additional information you would like to share with regards to your loan request.