ONLINE MORTGAGE REFERAL APPLICATION

IMPORTANT: DO NOT APPLY OR FILL THIS FORM, DUE TO EXTREMELY HIGH VOLUME, WE CAN NO LONGER ACCEPT NEW CLIENTS!!!!!!!! YOUR APPLICATION WILL NOT BE VIEWED. THIS WEBSITE IS FOR INFORMATIONAL PURPOSES ONLY

Please fill out the form below. Complete as much information as possible and we will contact you within 12 business hours. Or if you prefer, please call us at (877) MRATES-1 or (877) 672-8371 for assistance.

Do you currently own a home?

Yes     No

Loan Purpose :	Select a loan purpose... Purchase Second Mortgage Debt Consolidation 1st Mortgage Debt Consolidation 2nd Mortgage Refinance 1st Mortgage Refinance 2nd Mortgage Refinance with Cash Out - 1st Mortgage Refinance with Cash Out - 2nd Mortgage Home Equity Line of Credit
Type of Loan Desired:	Select Desired Loan Type... Undecided 30 Year Fixed 15 Year Fixed MTA Option ARM COSI Mortgage 3/1 ARM 5/1 ARM 7/1 ARM 10/1 ARM FHA VA Bad Credit (Subprime) No Doc Other (Explain in comments)

Loan Amount Desired:	Please Select 50,000 55,000 60,000 65,000 70,000 75,000 80,000 85,000 90,000 95,000 100,000 105,000 110,000 115,000 120,000 125,000 130,000 135,000 140,000 145,000 150,000 155,000 160,000 165,000 170,000 175,000 180,000 185,000 190,000 195,000 200,000 205,000 210,000 215,000 220,000 225,000 230,000 235,000 240,000 245,000 250,000 255,000 260,000 265,000 270,000 275,000 280,000 285,000 290,000 295,000 300,000 305,000 310,000 315,000 320,000 325,000 330,000 335,000 340,000 345,000 350,000 355,000 360,000 365,000 370,000 375,000 380,000 385,000 390,000 395,000 400,000 450,000 Up to 500,000 Up to 600,000 Up to 700,000 Up to 800,000 Up to 900,000 1,000,000 1,000,000 +
Primary Applicant Full Name:
Co-Applicant Full Name:
Street Address:
City:
State: (Sorry, AL or HI Residents not applicable)	AK AR AZ CA CO CT DC DE FL GA 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 UT TX UT VA VT WA WI WV WY
Zip Code:
Home Phone: ex. 555-555-1234
Work Phone: ex. 555-555-1234
If Purchasing, have you found a home:	Select your answer... No, I am still looking Yes, without purchase contract Yes, with signed purchase contract
Property Type:	Select your property... Single Family Residence Condominium Townhouse
Estimate Property Value:	Please Select 50,000 55,000 60,000 65,000 70,000 75,000 80,000 85,000 90,000 95,000 100,000 105,000 110,000 115,000 120,000 125,000 130,000 135,000 140,000 145,000 150,000 155,000 160,000 165,000 170,000 175,000 180,000 185,000 190,000 195,000 200,000 205,000 210,000 215,000 220,000 225,000 230,000 235,000 240,000 245,000 250,000 255,000 260,000 265,000 270,000 275,000 280,000 285,000 290,000 295,000 300,000 305,000 310,000 315,000 320,000 325,000 330,000 335,000 340,000 345,000 350,000 355,000 360,000 365,000 370,000 375,000 380,000 385,000 390,000 395,000 400,000 450,000 Up to 500,000 Up to 600,000 Up to 700,000 Up to 800,000 Up to 900,000 1,000,000 1,000,000 +

Amount Owed on 1st Mortgage: approx.	Please Select 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 55,000 60,000 65,000 70,000 75,000 80,000 85,000 90,000 95,000 100,000 105,000 110,000 115,000 120,000 125,000 130,000 135,000 140,000 145,000 150,000 155,000 160,000 165,000 170,000 175,000 180,000 185,000 190,000 195,000 200,000 205,000 210,000 215,000 220,000 225,000 230,000 235,000 240,000 245,000 250,000 255,000 260,000 265,000 270,000 275,000 280,000 285,000 290,000 295,000 300,000 305,000 310,000 315,000 320,000 325,000 330,000 335,000 340,000 345,000 350,000 355,000 360,000 365,000 370,000 375,000 380,000 385,000 390,000 395,000 400,000 425,000 425,000 - 450,000 450,000 - 475,000 475,000 - 500,000 550,000 - 600,000 600,000 - 650,000 650,000 - 700,000 700,000 - 750,000 750,000 - 800,000 800,000 - 850,000 850,000 - 900,000 900,000 - 950,000 950,000 - 1,000,000 1,000,000+
Current APR on 1st Mortgage: approx.	Please Select 5% 5.25% 5.5% 5.75% 6% 6.25% 6.5% 6.75% 7% 7.25% 7.5% 7.75% 8% 8.25% 8.5% 8.75% 9% 9.25% 9.5% 9.75% 10% 10.25% 10.5% 10.75% 11% 11.25% 11.5% 11.75% 12% 12.25% 12.5% 12.75% 13% 13.25% 13.5% 13.75% 14% 14.25% 14.5% 14.75% 15% 15.25% 15.5% 15.75% 16% 16.25% 16.5% 16.75% 17% 17.25% 17.5% 17.75% 18% 18.25% 18.5% 18.75% 19% 19.25% 19.5% 19.75% 20%
Fixed or Adjustable:	Select One.. Fixed Adjustable

Amount Owed on 2nd Mortgage: approx.	Not Applicable 5% 5.25% 5.5% 5.75% 6% 6.25% 6.5% 6.75% 7% 7.25% 7.5% 7.75% 8% 8.25% 8.5% 8.75% 9% 9.25% 9.5% 9.75% 10% 10.25% 10.5% 10.75% 11% 11.25% 11.5% 11.75% 12% 12.25% 12.5% 12.75% 13% 13.25% 13.5% 13.75% 14% 14.25% 14.5% 14.75% 15% 15.25% 15.5% 15.75% 16% 16.25% 16.5% 16.75% 17% 17.25% 17.5% 17.75% 18% 18.25% 18.5% 18.75% 19% 19.25% 19.5% 19.75% 20%
Current APR on 2nd Mortgage: approx.	Not Applicable 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 50,000 55,000 60,000 65,000 70,000 75,000 80,000 85,000 90,000 95,000 100,000 105,000 110,000 115,000 120,000 125,000 130,000 135,000 140,000 145,000 150,000 155,000 160,000 165,000 170,000 175,000 180,000 185,000 190,000 195,000 200,000 205,000 210,000 215,000 220,000 225,000 230,000 235,000 240,000 245,000 250,000 255,000 260,000 265,000 270,000 275,000 280,000 285,000 290,000 295,000 300,000 305,000 310,000 315,000 320,000 325,000 330,000 335,000 340,000 345,000 350,000 355,000 360,000 365,000 370,000 375,000 380,000 385,000 390,000 395,000 400,000 425,000 425,000 - 450,000 450,000 - 475,000 475,000 - 500,000 550,000 - 600,000 600,000 - 650,000 650,000 - 700,000 700,000 - 750,000 750,000 - 800,000 800,000 - 850,000 850,000 - 900,000 900,000 - 950,000 950,000 - 1,000,000 1,000,000+
Fixed or Adjustable:	Not Applicable Fixed Adjustable

Gross Yearly Household Income:
How is your Credit?	Make your best guess... Excellent Good Fair Poor

Best Time To Contact You:	Choose one... E-Mail Only Morning at Work Afternoon at Work Evening at Work Morning at Home Afternoon at Home Evening at Home
Current Email Address:
Receive future offers from us?	Yes     No
Additional Comments

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