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                  a FREE loan evaluation. Â 
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                  theLOWEST RATE 
            GUARANTEED!Â Â  We are a national mortgage 
                  lender referral service who specializes in helping people like 
                  you get the loans you need to:Pay off bills and stop 
                    creditors from calling
Make those long needed home 
                    improvements
Refinance your home at a 
                    better rate
Get cash out for nearly 
                    anything Â Â  Please complete this brief information 
                  request form. It only takes a few minutes, and there is 
                  absolutely no obligation!Â  All information is kept 
                  strictly confidential! Please complete all information. Thank 
                  you!
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                  Important RemindersYou must have at least 20% 
                    equity in homes value to qualify.
Loan Amount must be at 
                    least $30,000 or more.
TX or AL states do NOT 
                    qualify.
Sorry, No Mobile 
                    Homes. 
Free Mortgage Loan Analysis. No 
                  obligation!
ALL INFORMATION IS REQUIRED. THANK YOU!
 
Are you a home 
                              owner?Choose 
                                one... Yes
NoPrimary Applicant 
                            Name:
Co-Applicant Name:
Street Address:
City:
State:
Zip Code:
Home Phone:
Example: (334) 123-4567Work Phone:
Example: (342) 567-8901Property Type:Select your property...
Single 
                                Family Residence Condominium TownhouseOriginal Purchase 
                              Price:
Example: 100KYear Acquired:
Estimated Property 
                              Value:(Must be at least $50K)
Amount Owed on 1st 
                              Mortgage:
Current Interest Rateon 
                              1st Mortgage:
Fixed Or 
Adjustable?
 Choose 
                                one... Fixed AdjustableMonthly Payment on 1st 
                              Mortgage:
Amount Owed on 2nd 
                              Mortgage:
Current Interest Rateon 
                              2nd Mortgage:
Fixed or 
Adjustable?
 Choose 
                                one... Fixed AdjustableMonthly Payment on 2nd 
                              Mortgage:
Current Employer:
Years With Current 
                              Employer:
Gross Yearly 
Income:
Example: 60KHow is your credit?Make 
                                your best guess... Excellent Good Fair PoorBest Time To Contact 
                              You:
 Choose 
                                one... Morning at Work
Afternoon at 
                                Work Evening at Work
Morning at 
                                Home Afternoon at 
                                Home Evening at 
                              HomeType Of Loan 
                            Desired:
 Select a 
                                loan... Second Mortgage
Debt 
                                Consolidation Refinance Refinance with 
                                Cash Out Home Equity 
                                Line of CreditLoan Amount 
                              Desired:(Must be at least $30K)
Example: 80KYour E-Mail 
Address:
Must be in form: name@domain.com.Please 
                              verify. Thanks!Â 
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Please verify your information - especially 
                              your telephone numbers and e-mail address - before 
                              pressing the button.
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Thank 
                  you! You will be contacted by amortgage professional 
                  shortly.
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