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Application types:
purchase
refinance
home equity
Loan Information
Loan Term
30 Year Fixed
30 Year Fixed
15 Year Fixed
5 Yr Balloon
7 Yr Balloon
1/1 ARM
3/1 ARM
5/1 ARM
VA 30 Yr
FHA 30 Yr
FHA ARM
Loan Purpose
Purchase
Constr. Loan
See Comments/Other
FHA Loan
VA Loan
Loan Amount
Property Value
Estimated Timeframe
< 30 Days
30-60 Days
60-90 Days
Not Sure 120
Property Information
Property Type
-
Single family
Condo
Commercial
Investment
Co-op
Mobile Home
Multi Family
Address
City
State
Zip
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
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
TX
UT
VA
VT
WA
WI
WV
WY
Primary Borrower Information
First Name
Last Name
Social Security
-
-
Work Phone
Home Phone
Email
Employment Information
Self Employed
Years Employed
Annual Income($)
no
yes
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
< $20,000
$20,000-25,000
$25,000-30,000
$30,000-35,000
$35,000-40,000
$40,000-45,000
$45,000-50,000
$50,000-60,000
$60,000-70,000
$70,000-80,000
$80,000-90,000
$90,000-100,000
$100,000-125,000
$125,000-150,000
$150,000-175,000
$175,000-200,000
Income and Expense Information
Monthly Expenses($)
Credit History
Excellent
Good
Fair
Poor
4575 Royal Palm Square • Suite 209 • Fort Myers, Fl 33919
toll free (800) 460-1433
