Contact Information

First  Name          Last Name

Phone Number    Best time to call

Email Address 

Property Address: 

Street Address   City 

State                            Zip 

Mailing Address (if differs from property address or if property address unknown)

Street Address   City 

State                            Zip 

Property Information 

Type of/ Use of Property: Primary Residence Second / Vacation Property Investment Property

Loan Information 

Reason for a New Loan? (Please highlight and double click choice from window): Purchase Refinance Construction Cash Out

Loan Amount Requested:    Estimated Value of Property:

Current Loan Amount (1st Trust Deed): (2nd Trust Deed):

Current Interest Rate (1st Trust Deed):   (2nd Trust Deed):

Have you been turned down by another lender?

Credit Information

Household income: Total Current Debt:

How would you summarize your personal credit?

What is your current credit score (optional / if known):

Please list approximate value of current liquid assets such as bank accounts, stocks, IRAs, 401k etc...

Assets      $     How did you hear about us?

Thank you for taking the time to reach us. If we can help you, a representative will contact you soon. We look forward to developing a strong and long term relationship with you.