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12
Questions
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1
What's your name?
First Name
Last Name
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2
Can you provide us with your email address?
example@example.com
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3
Phone Number
Area Code
Phone Number
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4
What’s your ideal timeline for refinancing your mortgage?
NOW!
Within 3 months
Within 6 months
Longer than 6 months
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5
Have you been employed for at least 2 years?
YES
NO
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6
Are you a veteran or active-duty military?
YES
NO
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7
How much equity do you currently have in your home?
Please Select
0k-50k
50k-100k
100k-250k
250k-500k
Over 500k
Please Select
Please Select
0k-50k
50k-100k
100k-250k
250k-500k
Over 500k
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8
How much are you looking to borrow?
Please Select
0
10-50k
51-100k
101-150k
151k+
Please Select
Please Select
0
10-50k
51-100k
101-150k
151k+
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9
How would you rate your credit?
Poor (less than 580)
Good (660-720)
Fair (580-660)
Excellent - 720+
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10
What State Are You Located in?
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11
What Is Your Current Time Zone?
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12
When is the best time to reach out?
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