Your Name:


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Email Address:

Original Loan Amount
Current Loan Balance
(to the penny)
Original Term on current loan
Is your current loan an Interest Only mortgage?
Current Interest Rate
Original closing date of current loan (mm/dd/yy)
Next Payment Due Date (mm/dd/yy)
Current Total Monthly Payment (to the penny)
Are your taxes and insurance included in your payment?
Current Monthly Escrow Payment
Does your current payment include mortgage insurance?
Current Escrow Balance
Annual Property Taxes
Annual homeowner's insurance premium
Renewal date on your insurance policy (mm/dd/yy)
How much do you think your home is worth?
What loan type do you have now?
Is your current mortgage Fixed Rate or Adjustable Rate?
What term would you prefer on your new loan?
How much longer do you expect to own this home (and have a mortgage)?
Primary Purpose of the Refinance
Secondary Purpose of the Refinance
How do you wish to handle any closing costs or pre-paid expenses?
Have you made any external changes (added a pool, deck, etc.) to your property since your purchase?
Have you previously refinanced a mortgage on this property?
If yes, did you withdraw equity or combine a home improvement 2nd mortgage?
This mortgage is on my:
Do you currently have a 2nd mortgage?
(If yes, please provide details below)
Do you think your credit rating is
How did you hear about me?
Additional comments and details?