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Loan Purpose		Refinance Loan Modification Refinance with Cash Out Home Equity
Where is the Property Located?		Do you have a second mortgage?		First name
Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Mississippi Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming		Yes No
Property ZIP code		Second mortgage balance		Last name
		None 5,001 - 10,000 10,001 - 15,000 15,001 - 20,000 20,001 - 25,000 25,001 - 30,000 30,001 - 35,000 35,001 - 40,000 40,001 - 45,000 45,001 - 50,000 50,001 - 55,000 55,001 - 60,000 60,001 - 65,000 65,001 - 70,000 70,001 - 75,000 75,000 - 80,000 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001-110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 200,001 - 210,000 210,001 - 220,000 220,001 - 230,000 230,001 - 240,000 240,001 - 250,000 250,001 - 260,000 260,001 - 270,000 270,001 - 280,000 280,001 - 290,000 290,001 - 300,000 300,001 - 310,000 310,001 - 320,000 320,001 - 330,000 330,001 - 340,000 340,001 - 350,000 350,001 - 360,000 360,001 - 370,000 370,001 - 380,000 380,001 - 390,000 390,001 - 400,000 400,001 - 420,000 420,001 - 440,000 440,001 - 460,000 460,001 - 480,000 480,001 - 500,000 500,001 - 520,000 520,001 - 540,000 540,001 - 560,000 560,001 - 580,000 580,001 - 600,000 600,001 - 620,000 620,001 - 640,000 640,001 - 660,000 660,001 - 680,000 680,001 - 700,000 700,001 - 720,000 720,001 - 740,000 740,001 - 760,000 760,001 - 780,000 780,001 - 800,000 800,001 - 820,000 820,001 - 840,000 840,001 - 860,000 860,001 - 880,000 880,001 - 900,000 900,001 - 920,000 920,001 - 940,000 940,001 - 960,000 960,001 - 980,000 980,001 - 1,000,000 1,000,000+ 1,500,000+ 2,000,000+
Home description		Second mortgage interest rate %		Street address
Single Family Multi Family Town House Condominium (No mobile or manufactured homes)		Select One 3.0 3.125 3.250 3.375 3.500 3.625 3.750 3.875 4.00 4.125 4.250 4.375 4.500 4.625 4.750 4.875 5.0 5.125 5.250 5.375 5.500 5.625 5.750 5.875 6.00 6.125 6.250 6.375 6.500 6.625 6.750 6.875 7.00 7.125 7.250 7.375 7.500 7.625 7.750 7.875 8.00 8.125 8.250 8.375 8.500 8.625 8.750 8.875 9.00 9.125 9.250 9.375 9.500 9.625 9.750 9.875 10.00 10+
Purchase Year		How much additional cash would you like to borrow? How much cash do you want for your equity loan? How much debt do you wish to consolidate? $		City
2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946		Select One 0 1 - 5,000 5,001 - 10,000 10,001 - 15,000 15,001 - 20,000 20,001 - 25,000 25,001 - 30,000 30,001 - 35,000 35,001 - 40,000 40,001 - 45,000 45,001 - 50,000 50,001 - 55,000 55,001 - 60,000 60,001 - 65,000 65,001 - 70,000 70,001 - 75,000 75,000 - 80,000 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001-110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 200,001 - 210,000 210,001 - 220,000 220,001 - 230,000 230,001 - 240,000 240,001 - 250,000 250,001 - 260,000 260,001 - 270,000 270,001 - 280,000 280,001 - 290,000 290,001 - 300,000 300,001 - 310,000 310,001 - 320,000 320,001 - 330,000 330,001 - 340,000 340,001 - 350,000 350,001 - 360,000 360,001 - 370,000 370,001 - 380,000 380,001 - 390,000 390,001 - 400,000 400,001 - 420,000 420,001 - 440,000 440,001 - 460,000 460,001 - 480,000 480,001 - 500,000 500,001 - 520,000 520,001 - 540,000 540,001 - 560,000 560,001 - 580,000 580,001 - 600,000 600,001 - 620,000 620,001 - 640,000 640,001 - 660,000 660,001 - 680,000 680,001 - 700,000 700,001 - 720,000 720,001 - 740,000 740,001 - 760,000 760,001 - 780,000 780,001 - 800,000 800,001 - 820,000 820,001 - 840,000 840,001 - 860,000 860,001 - 880,000 880,001 - 900,000 900,001 - 920,000 920,001 - 940,000 940,001 - 960,000 960,001 - 980,000 980,001 - 1,000,000 1,000,000+ 1,500,000+ 2,000,000+
Property Use		Credit status		State
Primary Secondary Investment Vacation		Excellent Good Fair Poor		Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Mississippi Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Estimated home value $		Annual income		Zip
Select One 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001-110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 200,001 - 210,000 210,001 - 220,000 220,001 - 230,000 230,001 - 240,000 240,001 - 250,000 250,001 - 260,000 260,001 - 270,000 270,001 - 280,000 280,001 - 290,000 290,001 - 300,000 300,001 - 310,000 310,001 - 320,000 320,001 - 330,000 330,001 - 340,000 340,001 - 350,000 350,001 - 360,000 360,001 - 370,000 370,001 - 380,000 380,001 - 390,000 390,001 - 400,000 400,001 - 420,000 420,001 - 440,000 440,001 - 460,000 460,001 - 480,000 480,001 - 500,000 500,001 - 520,000 520,001 - 540,000 540,001 - 560,000 560,001 - 580,000 580,001 - 600,000 600,001 - 620,000 620,001 - 640,000 640,001 - 660,000 660,001 - 680,000 680,001 - 700,000 700,001 - 720,000 720,001 - 740,000 740,001 - 760,000 760,001 - 780,000 780,001 - 800,000 800,001 - 820,000 820,001 - 840,000 840,001 - 860,000 860,001 - 880,000 880,001 - 900,000 900,001 - 920,000 920,001 - 940,000 940,001 - 960,000 960,001 - 980,000 980,001 - 1,000,000 Over 1,000,000		Less than 30,000 30,000 - 44,999 45,000 - 59,999 60,000 - 74,999 75,000 - 89,999 90,000 - 104,999 105,000 - 120,000 Over 120,000
Down payment amount $		Occupational status		Email
Down Payment Amount 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%		Employed Self Employed Retired Unemployed
First mortgage balance		Have you ever declared bankruptcy?		Primary phone
Select One 50,001 - 55,000 55,001 - 60,000 60,001 - 65,000 65,001 - 70,000 70,001 - 75,000 75,000 - 80,000 80,001 - 85,000 85,001 - 90,000 90,001 - 95,000 95,001 - 100,000 100,001 - 105,000 105,001-110,000 110,001 - 115,000 115,001 - 120,000 120,001 - 125,000 125,001 - 130,000 130,001 - 135,000 135,001 - 140,000 140,001 - 145,000 145,001 - 150,000 150,001 - 155,000 155,001 - 160,000 160,001 - 165,000 165,001 - 170,000 170,001 - 175,000 175,001 - 180,000 180,001 - 185,000 185,001 - 190,000 190,001 - 195,000 195,001 - 200,000 200,001 - 210,000 210,001 - 220,000 220,001 - 230,000 230,001 - 240,000 240,001 - 250,000 250,001 - 260,000 260,001 - 270,000 270,001 - 280,000 280,001 - 290,000 290,001 - 300,000 300,001 - 310,000 310,001 - 320,000 320,001 - 330,000 330,001 - 340,000 340,001 - 350,000 350,001 - 360,000 360,001 - 370,000 370,001 - 380,000 380,001 - 390,000 390,001 - 400,000 400,001 - 420,000 420,001 - 440,000 440,001 - 460,000 460,001 - 480,000 480,001 - 500,000 500,001 - 520,000 520,001 - 540,000 540,001 - 560,000 560,001 - 580,000 580,001 - 600,000 600,001 - 620,000 620,001 - 640,000 640,001 - 660,000 660,001 - 680,000 680,001 - 700,000 700,001 - 720,000 720,001 - 740,000 740,001 - 760,000 760,001 - 780,000 780,001 - 800,000 800,001 - 820,000 820,001 - 840,000 840,001 - 860,000 860,001 - 880,000 880,001 - 900,000 900,001 - 920,000 920,001 - 940,000 940,001 - 960,000 960,001 - 980,000 980,001 - 1,000,000 1,000,000+ 1,500,000+ 2,000,000+		No/Not in Past 7 Years 5 – 7 Years Ago 2 – 5 Years Ago 1 – 2 Years Ago Less Than 12 Months Ago
First mortgage interest rate %		Monthly debt payments		Secondary phone
Select One 3.0 3.125 3.250 3.375 3.500 3.625 3.750 3.875 4.00 4.125 4.250 4.375 4.500 4.625 4.750 4.875 5.0 5.125 5.250 5.375 5.500 5.625 5.750 5.875 6.00 6.125 6.250 6.375 6.500 6.625 6.750 6.875 7.00 7.125 7.250 7.375 7.500 7.625 7.750 7.875 8.00 8.125 8.250 8.375 8.500 8.625 8.750 8.875 9.00 9.125 9.250 9.375 9.500 9.625 9.750 9.875 10.00 10+		Select 0-249 250-499 500-749 750-1,000 Over 1,000 (do not include housing)
Existing Rate Type				Best contact time
Fixed Adjustable Fixed/Adj				Morning on Primary Morning on Secondary Afternoon on Primary Afternoon on Secondary Evening on Primary Evening on Secondary
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