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Title: Where Smart People Shop for Mortgages

Fill out this short form or call 888-418-2575.  If your loan request is to purchase a home click here. * All fields are required; please enter N/A in those fields which do not apply to your circumstances. First and Last Name Co-Applicant's Name City State  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VI VA WA WV WI WY (where the home is located) We do not have lenders that make loans outside the USA. Street Address Zip Work Phone 000-000-0000 Home Phone 000-000-0000 Type of House Owned  Single Family Condo Townhouse Multi-Family Current Value   (enter numbers only, i.e. 70000) Purchase Price (enter numbers only, i.e. 50000) Total Mortgage Balance (enter numbers only i.e. 45000, if you owe zero enter 1) Interest Rate Fixed or Adjustable? Fixed Adjustable Not sure Monthly Payment Behind on Payments? Yes No How Would Your Rate Your Credit? Poor Fair Good Excellent Place of Employment Years There 0-2 years 2-5 years 5 to 10 years over 10 years Yearly Income Best Time to Call Loan Amount Desired 20,000 - 30,000 30,000 - 50,000 50,000 - 100,000 100,000 - 200, 000 200,000 - 400, 000 400,000+ Type of Loan Desired Second Mortgage Debt Consolidation Home Improvement Refinance If your loan request is to purchase a home click here. Email Address Additional information that you think may be helpful. May we have your permission to send you occasional special offers by email? Yes No All information collected is treated as strictly confidential and will only be used for the purposes of a real estate loan application.  We will never sell your name to a third party marketer. If for any reason, you can not submit the form, you can call us and submit your info over the phone at 1-888-418-2575 or you can fax the above information to Fax 1-888-738-2998. Copyright 2000 eWorld Marketing Inc. Terms of Service