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Borrower Name: First:	Middle: Last:
Co-Borrower Name: First:	Middle: Last:
Street Address:
City:	State: Zip:
Contact Information
Borrower Email:
Co-Borrower Email:
Phone Numbers
Day:	Evening: Fax:
How would you like to be contacted? (Select all that apply)
Email: Day Phone: Evening Phone:

What is the approximate value of subject property?
What type of property do you own?
If the property is a condo or townhome, what are your monthly HOA dues?
What is the approximate balance on your mortgage?
What is your current rate?
What is your current payment?
Does it include all property taxes and insurance?		Yes No Not Sure
Are you currently paying Private Mortgage Insurance (PMI)?		Yes No Not Sure
If so, how much?
Do you have any 2nd mortgages or Home Equity Lines of Credit (HELOC)?		Yes No
If so, what is the balance?
If so, what is the rate?
If so, what is the payment?
Why are you interested in refinancing your home? (Select all that apply.)		Lower Payments Consolidate Debt Pull cash out of the transaction
Do you plan on being in the home longer than 5 years from now?		Yes No Not Sure
What is the combined gross household income (monthly or annually)?
Is anyone applying for this loan self employed?		Yes No
What is the current minimum monthly debt obligation for all consumer debt (aside from existing mortgages) including car loans, student loans, credit cards, etc.?
How is your credit history rating?
Do you have a loan officer that you would like to work with?

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3212 NW Byron Street, Suite # 103
Silverdale, WA 98383
360-692-3534 - Office / 360-692-8466 - Fax