Applicant Name:

Co-Applicant Name:

Street Address:

City, State, Zip Code:

Daytime phone (include area code):

Best time of day to call, Morning or Afternoon

E-mail address:

Are you ? (select one) Purchasing a new home Refinancing an existing mortgage Seeking a construction loan, second morgage or home improvement loan

Is this a ? (select one) Primary residence Second home Investment property

Are you a first-time homebuyer? Yes or No

Is the property a ? (select one) Single family home Multi family home Condominium

Address of property:

What type of mortgage are you seeking? (select one) 30 year fixed 20 year fixed 15 year fixed 10 year fixed Adjustable rate mortgage Not sure

Approximately how much do you need to borrow? (select one) Less than $100,000 $100,000 - $150,000 $150,000 - $200,000 $200,000 - 250,000 $250,000 - $300,000 More than $300,000

Certification and Authorization
By clicking “Submit” below, I acknowledge that this form represents a preliminary inquiry only and that a formal application will be required upon review by a loan officer.