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About You First Name: Last Name: Address: City: State: Select Hawai'i AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NY NC ND OH OK OR PA OR RI SC SD TN TX UT VT VA WA WV WI WY Zip: Phone: Fax: eMail:   Property Information Is Property address the same as above : Yes : No: If 'No' please provide the subject Property Address below : Address: City: State: Select Hawai'i AL AK AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NY NC ND OH OK OR PA OR RI SC SD TN TX UT VT VA WA WV WI WY Zip: Property Type : select Single Family Detached Town home Condominium /Detached (CPR land and PUD) Condominium Attached (4-Floors or Less) Condominium Attached (5-Floors and Higher) 2-unit (Duplex) 3-unit (Triplex) 4-unit (Fourplex) Leasehold: Fee Simple: Estimated Property Value: What type of loan are you looking for : select Purchase Refinance (lower payments only, no cash out) Refinance w/Cash Out Construction (residential only) Amount owed on 1st Mortgage : Current 1st Mortgage Type : select 30-year Fixed Adjustable 1 Yr Adjustable 2 Yr Adjustable 3 Yr Adjustable 5 Yr Adjustable 7 Yr Other Current 1st Mortage Rate : Amount you owe on any 2nd Mortgage (Home equity line of credit included): : Current 2nd Mortgage Type : select Fixed Equity Line - Adjustable Other Current 2nd Mortage Rate : Total of other debt minimum monthly payment amounts (Auto loans, installment loans, student loans, credit cards, etc.) : How would you rate your credit :   select Excellent (Always pay on time/no large balances) Good (Always pay on time, some balances on credit cards, etc) Fair (Pays on time, but sometimes late and carrying some credit card debt) Poor (Mortgage lates, late payments and/or high balances on c/c, etc.) What is the best day and time to call you? : Additional information or comments:

We lend exclusively in Hawaii, California, Colorado, Florida, Alaska, Virginia, Michigan, Minnesota, New Mexico, Oregon and Washington. Hawaii loans are made pursuant to the Dept of Commerce & Consumer Affairs. License No: MB-886.California Loans are made pursuant to the California Department of Real Estate, License No. 01333905. DRE information line 916-227-0931. Colorado loans are made pursuant to the State Department of Regulatory Agencies-Real Estate Division, License No. 20041197634. Florida loans are made pursuant to the Dept of Financial Services. License No: 306346. Information Line: 850-410-9895. Virginia loans are made pursuant to the Bureau of Financial Institutions. License No: MB-2150. Alaska loans are made pursuant to the Dept of Community & Economic Development. License No: 298979.Michigan loans are made pursuant to the Michigan Department of Labor & Economic Growth. License No: FL0014454. Minnesota loans are made pursuant to the State of Minnesota Department of Commerce. License No: MO20592722. New Mexico loans are made pursuant to the State of New Mexico Regulation & Licensing Department Financial Institutions Division. License No: 02999. Oregon loans are made pursuant to the Oregon Department of Consumer & Business Services. License No: ML-4270. Washington Loans are made pursuant to the State of Washington Department of Financial Institutions. License No: 520-CL-30624.