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Borrowers may not qualify for all programs.  All loans subject to approval, restrictions may apply. RI Licensed Broker 92000366, MA Licensed Broker  #MB1818, CT Licensed Broker  #11282

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First Name                                    MI                       Last Name Home Phone                                                           Work Phone City                                                                         Zip Code Best time to contact you 1. What state is the property in? 2. What is the estimated current value of the home? 3. What is the total amount you need to finance? 4. The purpose of this loan is: 5. What type of loan do you want? 6. What is your desired loan term? 7. Have you declared bankruptcy in the last seven years? 8. What best describes your credit? 9. Do you pay your monthly payments on time? 10. What is your gross monthly income (pre-tax)? You do not need to include information about alimony, child support or separate maintenance income unless you want it to be considered. 11. How much are your current monthly payments? Include all monthly obligations for you and your co-borrower such as credit card minimums, car loan, or child support (excluding housing). Rhode Island Massachusetts Connecticut $ .00 $ .00 New Purchase Refinance Bill Consolidation Home Improvement Cash Out New Purchase Refinance Home Equity Loan Debt Consolidation 30 Fixed 15 Fixed 3/1 Arm 5/1 Arm 7/1 Arm FHA VA No Less than 12 months ago 1-2 years ago 2-5 years ago 5-7 years ago More than 7 years ago Excellent Good Fair Some problems Major problems Early On time 1-3 months late 4-6 months late over 6 months $ .00 $ .00