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First
Name |
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Last Name |
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Co-Applicant's First Name |
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Last Name |
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City |
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State /
Province |
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Where home is located |
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Street
Address |
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Zip /
Postal Code |
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UNITED STATES and CANADA Homeowners ONLY
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Home
Phone |
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- - You must provide at least one valid phone
number |
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Work or
Other Phone |
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- - |
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Are You
a Home Owner |
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Mobile Homes DO NOT Qualify
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Type of
House Owned |
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Year
Acquired |
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i.e.
1995 |
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Current
Property Value |
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enter numbers
only i.e. 135000 |
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Purchase
Price |
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enter numbers only i.e. 95000 |
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Total
Mortgage Balance |
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If you owe zero - enter
000 |
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Interest
Rate |
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enter numbers only i.e.
8.15 |
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Fixed or
Adjustable |
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Monthly
Payment |
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enter numbers only i.e.
1500 |
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Behind
on Payments |
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How
Would You Rate Your Credit |
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-- Damaged credit is not a problem |
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Total
Amount of All Current Liens |
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enter numbers only i.e. 2500 - If None enter
000 |
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Place of
Employment |
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Years
There |
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Yearly
Income |
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enter numbers only i.e. 60000 |
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Best
Time / Place to Call |
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Loan
Amount Desired |
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($25,000 Minimum Loan Amount)
--enter numbers only i.e.
125000
(Loan Amount Desired
may not be more than 90% of current property
value)
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Type of
Loan Desired |
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Email
Address |
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Additional information that
you think might be
helpful. |
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