Name			Rate Your Credit Excellent Good Fair Poor
Address			Cty
State			Zip
Email Address		$	Value of your Home
Phone		$	Loan Balance
Do you have any home equity financing No Yes		$	Home Equity Balance (if applicable)
Are you Refinancing Home Equity Loan No Yes		$	Would you Like Additional Cash (Amount)
Property Type Single Family Townhome Condominium		$	Monthly Association Fees (if Applicable)
Occupancy Status Primary Second Home Investment Property		$	Total Monthly Debt
BK or Foreclosure in past 7 years No Yes		$	Total Gross Monthly Income
Years planning to live in home 1 2 3 4 5 6 7 8 9 10+			Points you prefer to pay

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