PreQualify for Refinance

1.	What type of home do you own?	Primary - Single Family Primary - Condo Primary - Mobile Home Primary - Townhome Primary - Multiple Family Dwelling 2nd Home - Condo 2nd Home - Mobile Home 2nd Home/Vacation - Single Family 2nd Home - Townhome 2nd Home - Multiple Family Dwelling Investment - Condo Investment - Mobile Home Investment - Townhome Investment - Multiple Family Dwelling
2.	Please estimate your home's current value:	Select $50,000 or less $50,001 - $75,000 $75,001 - $100,000 $100,001 - $125,000 $125,001 - $150,000 $150,001 - $175,000 $175,001 - $200,000 $200,001 - $225,000 $225,001 - $250,000 $250,001 - $275,000 $275,001 - $300,000 $300,001 - $325,000 $325,001 - $350,000 $350,001 - $375,000 $375,001 - $400,000 $400,001 - $425,000 $425,001 - $450,000 $450,001 - $475,000 $475,001 - $500,000 $500,001 - $525,000 $525,001 - $550,000 $550,001 - $575,000 $575,001 - $600,000 $600,001 - $625,000 $625,001 - $650,000 $650,001 - $675,000 $675,001 - $700,000 $700,001 - $725,000 $725,001 - $750,000 $750,001 - $775,000 $775,001 - $800,000 $800,001 - $825,000 $825,001 - $850,000 $850,001 - $875,000 $875,001 - $900,000 $900,001 - $925,000 $925,001 - $950,000 $950,001 - $975,000 $975,001 - $1,000,000 Over $1,000,000
3.	The loan balance on your 1st mortgage is:	Select $20,000 or less $20,001 - $45,000 $45,001 - $70,000 $70,001 - $95,000 $95,001 - $120,000 $120,001 - $145,000 $145,001 - $170,000 $170,001 - $195,000 $195,001 - $220,000 $220,001 - $245,000 $245,001 - $270,000 $270,001 - $295,000 $295,001 - $320,000 $320,001 - $345,000 $345,001 - $370,000 $370,001 - $395,000 $395,001 - $420,000 $420,001 - $445,000 $445,001 - $470,000 $470,001 - $495,000 $495,001 - $520,000 $520,001 - $545,000 $545,001 - $570,000 $570,001 - $595,000 $595,001 - $620,000 $620,001 - $645,000 $645,001 - $670,000 $670,001 - $695,000 $695,001 - $720,000 $720,001 - $745,000 $745,001 - $770,000 $770,001 - $795,000 $795,001 - $820,000 $820,001 - $845,000 $845,001 - $870,000 $870,001 - $895,000 $895,001 - $920,000 $920,001 - $945,000 $990,001 - $995,000 $995,001 - $1,000,000 Over $1,000,000
4.	How much additional cash do you wish to borrow?	Select None $20,000 or less $20,001 - $25,000 $25,001 - $30,000 $30,001 - $35,000 $35,001 - $40,000 $40,001 - $45,000 $45,001 - $50,000 $50,001 - $55,000 $55,001 - $60,000 $60,001 - $65,000 $65,001 - $70,000 $70,001 - $75,000 $75,001 - $80,000 $80,001 - $85,000 $85,001 - $90,000 $90,001 - $95,000 $95,001 - $100,000 $100,001 - $105,000 $105,001 - $110,000 $110,001 - $115,000 $115,001 - $120,000 $120,001 - $125,000 $125,001 - $130,000 $130,001 - $135,000 $135,001 - $140,000 $140,001 - $145,000 $145,001 - $150,000 Over $150,000
5.	What is your current interest rate?	Select (pick closest value) 3.0 % or less 3.5 % 4.0 % 4.5 % 5.0 % 5.5 % 6.0 % 6.5 % 7.0 % 7.5 % 8.0 % 8.5 % 9.0 % 9.5 % 10.0 % 11.0 % 12.0 % Over 12.0 %
6.	Your current type of rate is:	Fixed Adjustable / ARM Interest Only Other
7.	Do you have a second mortgage?	Yes No
8.	If you have a 2nd mortgage, what is the current balance?	Select $20,000 or less $20,001 - $45,000 $45,001 - $70,000 $70,001 - $95,000 $95,001 - $120,000 $120,001 - $145,000 $145,001 - $170,000 $170,001 - $195,000 $195,001 - $220,000 $220,001 - $245,000 $225,001 - $250,000 $250,001 - $275,000 $275,001 - $300,000 $300,001 - $325,000 $325,001 - $350,000 $350,001 - $375,000 $375,001 - $400,000 $400,001 - $425,000 $425,001 - $450,000 $450,001 - $475,000 $475,001 - $500,000 $575,001 - $600,000 $600,001 - $625,000 $625,001 - $650,000 $650,001 - $675,000 $675,001 - $700,000 $700,001 - $725,000 $725,001 - $750,000 $750,001 - $775,000 $775,001 - $800,000 $800,001 - $825,000 $825,001 - $850,000 $850,001 - $875,000 $875,001 - $900,000 $900,001 - $925,000 $925,001 - $950,000 $950,001 - $975,000 $975,001 - $1,000,000 Over $1,000,000
9.	If you have a 2nd mortgage, how much is the monthly payment?	Select $400 or less $401 - $500 $501 - $600 $601 - $700 $701 - $800 $801 - $900 $901 - $1,000 $1,001 - $1,250 $1,251 - $1,500 $1,501 - $1,750 $1,751 - $2,000 $2,001 - $2,500 $2,501 - $3,000 $3,001 - $4,000 $4,001 - $5,000 $5,001 - $6,000 $6,001 - $7,000 Over $7,000
10.	What is your household's Gross Annual income?	Select $30,000 or less $30,001 - $45,000 $45,001 - $60,000 $60,001 - $75,000 $75,001 - $90,000 $90,001 - $105,000 $105,001 - $120,000 Over $120,000
11.	Please estimate your credit history:	Select Excellent Good Fair Needs Improvement Poor
12.	Have you had a foreclosure or filed bankruptcy in the last 7 yrs?	No 1 Year Ago 2 Years Ago 3 Years Ago 4 Years Ago 5 Years Ago 6 Years Ago 7 Years Ago
13.	Your name:	First Last
14.	Your E-mail address: (jdoe@msn.com)
15.	City, State, Zip Code:	Select 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
16.	How long have you been at your current job?	Less than 6 months 6-12 months 1-2 years More than 2 years Retired
17.	Are you self employed?	Yes No
18.	Please supply your home and work phone numbers:	Home
19.	Work phone number not Required	Work Ext.
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