Applicant & Co-Applicant Information
* Applicant First and Last Name:
Home Phone:
Work Phone:
Cell Phone:
* Email Address:
SSN:
OK to pull credit?	Select One Please... Yes No
Co-Applicant Information
Co-Applicant First & Last Name
Home Phone:
Work Phone:
Cell Phone:
Email Address:
SSN:
OK to pull credit?	Select One Please... Yes No
Current Address Information
Street Address:
City:
State:
Zip:
Years at address:	Select One 1 Year 2 Years 3 Years 4 Years 5 or more Yeras
Current Mortgage Information
1st Mortgage balance:	$
Current Interest Rate:	$ %
Current Payment:	$
How much is escrow (taxs & insurance)?	$
2nd Mortgage balance:	$
Current Interest Rate:	$ %
Current Payment:	$
Income Information
Applicant Monthly Income:	$
Co-Applicant Monthly Income:	$
Asset Information
Total Assets (401k/stocks/bonds/etc.):	$
Employment Information
Applicant's Employer:
Years employed:	Years
Co-Applicant's Employer:
Years employed:	Years
Debt Information
Amount of your debt:	Select One $0 - $4,999 $5000 - $9,999 $10,000 - $14,999 $15,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,999 $100,000+
Total monthly payments:	$
Type of Loan You Are Requesting
Loan Type:	Select One Please... Refinance Purchase Cash Out Refinance Construction Loan Other
Residence Type:	Select One Please... Primary Residence Second Home Non-Owner/Investment Other
Loan Term:	Select One Please... 45 Year Fixed 40 Year Fixed 30 Year Fixed 25 Year Fixed 20 Year Fixed 15 Year Fixed 10 Year Fixed Adjustable Rate Mortgage Lowest Payment
Estimated Loan amount:	$
Contact Information
Best time to call:	Select One Please... 9am - 11am 11am - 1pm 1pm - 3pm 3pm - 5pm 5pm - 7pm
Contact my by:	Select One Please... Home Phone Cell Phone Work Phone Email
Other Information
How did you hear about us?	Select One Please... Browsing the Web Radio   - KBIQ / Q102   - KVOR   - Y96.9 / KCCY   - Cat Country 95.1   - Peak FM - 92.9   - KKLI (K-Lite) Television Yellow Pages Referral Mailer Other (please explain)
Please tell us what you would like to accomplish with this loan.