As part of our Client for Life program, we want to stay up-to-date on your real estate and home-financing needs. Thank you in advance for answering these questions.
Your Name
Current Address
City
State
Zip
Phone Number
Email Address
Please answer to the nearest approximations for the following questions:
Remaining years left on your mortgage:
Current monthly principal and interest payment:
Current balance on your mortgage:
Current appraised/market value of your home:
Are you presently paying Private Mortgage Insurance?
Yes No
In how many years do you plan to retire? 
Have you made any major improvements to your home?
Answer:
Yes No
If yes, please explain:
Date of improvements:
Have you made any principal mortgage deductions in the past year?
Answer:
Yes No I would like more information
Please explain:
Please list any specific payment and equity objectives requarding your home loan.
Answer:
Yes No
Are you considering a vacation home, investment property, or home improvement loan?
Answer:
Yes No
If yes, please explain:
Do you plan to relocate in the future?
Answer:
Yes No
If yes, when
Estimate how long you will continure to live in this home.
Answer:
1-2 Years 3-5 Years 6-7 Years 8-10 Years 10 Years or more
What friends or associates do you know who might benefit from having a complete Mortgage Review?
With their permission, please provide their names and phone numbers below: