Refinance Multipurpose Marketing & Cold Calling Form

1
What’s Your Main Reason For Refinancing?* This field is required.Please select all reasons that apply to your current refinance goals. Your selections will help us identify the best loan options based on your needs and financial profile.
Lower My Monthly Payment
Get Cash Out
Consolidate Debt
Shorten Loan Term
VA IRRRL (Streamline)
FHA (Streamline)
HELOC (Home Equity Line/Loan Of Credit)
Add A Co-Borrower Or Spouse To The Mortgage
Remove A Co-Borrower / Ex-Spouse From The Loan
Switch From FHA To Conventional (To Remove PMI or Escrow)
Refinance Due To Divorce Decree
Restructure Loan After Forbearance Or Bankruptcy
Estate Or Probate-Related Refinance
2
Name* This field is required.
First Name
Last Name
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Email* This field is required.
example@example.com
5
Property Address* This field is required.Florida Residence Only
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Martial Status* This field is required.Select One
Single/Never Married
Married
Married But Separated
Divorce
Widow/Widower
7
Are You A VA Homeowner With A Current VA Mortgage?* This field is required.
YESNO
8
How Many Borrowers Will Be Applying For This Loan?* This field is required.Select the total number of people who will be listed on the loan application. This helps us determine income, credit, and program eligibility.
Please Select
Please Select
1 Borrower
2 Borrowers
3 Borrowers
Choose “1” if applying alone or “2” if applying with a co‑borrower or spouse.
9
What’s Your Estimated Credit Score?* This field is required.Select the option that best matches your current estimated credit score. This helps us suggest programs and rates you may qualify for.
Please Select
Please Select
Excellent (720+)
Good (680–719)
Fair (620–679)
Low (580–619)
Below (580)
Not sure? Choose your best estimate or use a recent credit report.
10
Monthly Income Before Taxes* This field is required.Include all sources of monthly income before taxes are deducted (e.g., salary, hourly wages, overtime, bonuses, etc.).
If applying jointly, enter combined income for all borrowers.
11
Are you currently employed?* This field is required.
YES
NO
12
Type of income* This field is required.Select All That Apply
W-2
1099
Self-Employed
Retirement
Pension Income
Social Security/Disability
Child Support
Alimony
Rental Income
Unemployment
13
Estimated Current Home Value* This field is required.Enter the estimated market value of your home based on a recent appraisal, online estimate (Zillow, Redfin, etc.), or your own knowledge.
$ Amount – Numbers only, no commas or symbols needed.
14
Current Mortgage Balance* This field is required.Enter the total amount you currently owe on your mortgage. This helps us determine how much equity you have in your home and what refinance options may be available.
Example: Enter remaining loan balance such as 245000
15
Current Interest Rate* This field is required.Enter the interest rate on your current mortgage. This helps us assess potential savings and identify refinance options that may lower your monthly payment or shorten your loan term.
Include the rate as a percentage (e.g., 6.25)
16
Have You Had Any Mortgage Late Payments In The Past 12 Months?* This field is required.Lenders use mortgage payment history as a key factor when reviewing refinance applications. Let us know if you’ve had any late payments recently so we can better match you with available loan options. Select "Yes" if you were 30 days or more late on a mortgage payment within the last 12 months.
YESNO
17
Are You Behind On Current Monthly Payments?
YES
NO
18
Do You Have Any Of The Following Monthly Obligations?* This field is required.Select All That Apply
Auto loan
Credit card balances
Student loans
Medical Bills / Collections
Buy Now, Pay Later Accounts (e.g., Affirm, Klarna)
Child Support / Alimony Payments
IRS Payment Plans / Back Taxes
Judgment or Court-Ordered Payments
Furniture or Appliance Financing (e.g., Conn’s, Ashley, Best Buy)
Timeshare Payments
Payday Loans / Title Loans
19
Estimated Monthly Debt Payments* This field is required.Enter the total amount you pay monthly toward debts such as credit cards, auto loans, student loans, personal loans, and other recurring obligations. This helps us calculate your estimated debt-to-income (DTI) ratio.
Include minimum payments only — do not include your current mortgage payment.
20
Loan Amount RequestedEnter the amount of cash you would like to receive from your refinance. This will help us determine available options based on your home equity and credit profile.
This applies only if you're requesting cash out or a home equity loan/line of credit.
21
Permission & DisclaimerThis is not a commitment to lend. Loan approval is subject to underwriting guidelines, investor requirements, and program availability. Terms, conditions, and programs are subject to change without notice. Rates and terms may vary based on the applicant’s credit profile and other qualifying factors. Not all applicants will qualify. Zion Investors Mortgage Lending (NMLS# 2617658) is an Equal Housing Lender.
I agree to be contacted by Zion Investors Mortgage Lending (NMLS# 2617658) by phone, email, and text message regarding my refinance inquiry. Message and data rates may apply. I can unsubscribe at any time.
Should be Empty: