Indicates a required field.  Type of Mortgage and Terms of Loan  Mortgage Applied For Select One Conventional FHA FmHA V.A. Other        Other:   Loan Amount $  Interest Rate %        No. of Months   Amortization Type: Select One 1 Month ARM 3 Month ARM 6 Month ARM 1 Year ARM 3 Year ARM 5 Year ARM 10 Year ARM 10 Year Fixed 15 Year Fixed 20 Year Fixed 30 Year Fixed GPM Other         Referred By: Search Engine Radio Newspaper Referral Other        Property Information  Property Address   City, State, Zip , 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  County  No. of Units  Year Built  Occupancy Primary Residence Secondary Residence Non-Owner Occupied    Appraised Value        Purpose of Loan  Loan Purpose:  Purchase Refinance: Improve rate and/or terms Refinance: Cash Out Refinance: Debt Consolidation Construction Construction-Permanent Other    Refinance   (Complete Below)    Construction or Construction-Permanent   (Complete Below)    If Refi, Yr Acquired    Year Lot Acquired    If Refi, Original Cost $    Original Cost $    If Refi, Exisiting Lien Amt $    Existing Lien Amt $    Refinance Purpose    Present Lot Value $    Improvements Select One Made To be made        Cost: $    Cost of Improvements $  Title Information  Title will be held  in what Name(s)  Title will be held  in what manner  Source of down  payment  Estate will be held in  Lease Exp Date Select One Fee Simple Leasehold

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