How did you hear about us:   

  Purpose of loan: Purchase, home has been identified Purchase, I am still looking for a property Refinance Construction Home Equity Line/Loan

  Purchase price or property value?  

  Approximate loan amount requested:  or % down :

  Loan program: Rural development - 0% down Ohio Housing Finance Agency 100% Conforming 30 year fixed Conforming 20 year fixed Conforming 15 year fixed Conforming 10 year fixed Flex 97 - 3% down FHA 30 year fixed FHA 15 year fixed FHA adjustable VA 30 year fixed VA 15 year fixed VA adjustable Conventional - 0% down Conforming 10/1 ARM Conforming 7/1 ARM Conforming 5/1 ARM Conforming 3/1 ARM Conforming interest only ARM Jumbo 30 year fixed Jumbo 20 year fixed Jumbo 15 year fixed Jumbo ARM No income verification Not sure which loan program I want

  Borrower First & Last Name:                                        Co-borrower First & Last Name:   

  Borrower SS#:    Co-borrower SS#:  

  Borrower gross monthly income:  

Co-borrower  gross monthly income:  

  Street Address:      City: 

  State:    Zip Code: 

  Email Address:

  Contact me at Home Work

  Borrower  phone:    Borrower work phone:

  Best time to contact between 9 am to 5 pm : 

  Co-borrower phone:   Co-borrower work phone:

  Best time to call co-borrower:  

  Do you want to lock a rate? Yes No  

  My/Our Credit History is: Excellent OK, but minor problems Has major credit problems

  Other questions or comments:

  A loan representative will contact you within 24 hours of your loan submission.