Name:
Phone:
-
-
Email:
Subject:
Notes /
Questions:
Debt Analysis - Please fill-in the following form:
1. Full Legal Name:
2. Address:
3. City:
State:
--
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP:
4. Email:
5. Phone:
-
-
6. 1st Mortgage Balance:
7. Current Interest Rate:
8. Monthly Payment:
9. Taxes/Insurance Included?
--
yes
no
10. Approximately how much are your taxes/year?
11. Approximately how much is your insurance/year?
12. 2nd Mortgage Balance:
13. Current Interest Rate:
14. Monthly Payment:
15. Amount of debt you would like to consolidate:
16. Current monthly payments for this debt amount:
17. Approximate average interest rate on this debt:
18. What is the annual pre-tax income of all Borrowers on the loan?
19. Have you been at your job or in the same line of work for at least 2 years?
--
yes
no
20. How much is your home worth?
Would you like us to find out for you? Just provide the following:
1. Home style:
2. Bedrooms:
3. Bathrooms:
4. Square Footage:
5. Garage:
- Please Select -
1 car
2 car - attached
2 car - detached
6. Basement:
- Please Select -
no
yes - unfinished
yes - finished
7. Any Acreage:
8. Age of your home:
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