Property State : Select an optionAKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Type of Home : Select an optionSingle FamilyMulti-FamilyTownhouseCondominium Your Credit Profile : Select an optionExcellentGoodFairPoorUnsure NEXT Estimate your total credit card debt : Select an optionLess than $2,500$2,501 - $5,0005,001 - $10,000$10,001 - $15,000$15,001 - $20,000$20,001 - $25,000$25,001 - $30,000$30,001 - $35,00035,001 - $40,000$40,001 - $45,000$45,001 - $50,000$50,000+ Estimate any other unsecured debt you have (including personal lines, medical bills, legal bills, etc.): Select an optionLess than $2,500$2,501 - $5,000$5,001 - $10,000$10,001 - $15,000$15,001 - $20,000$20,001 - $25,000$25,001 - $30,000$30,001 - $35,00035,001 - $40,000$40,001 - $45,000$45,001 - $50,000$50,000+ Estimate the current value of your property: Select an optionLess than $100,000$100,001 - $110,000$110,001 - $120,000$120,001 - $130,000$130,001 - $140,000$140,001 - $150,000$150,001 - $160,000$160,001 - $170,000$170,001 - $180,000$180,001 - $190,000$190,001 - $200,000$200,001 - $210,000$220,001 - $230,000$230,001 - $240,000$240,001 - $250,000$250,001 - $275,000$275,001 - $300,000$300,001 - $325,000$325,001 - $350,000$350,001 - $375,000$375,001 - $400,000$400,001 - $425,000$425,001 - $450,000$450,001 - $475,000$475,001 - $500,000$525,001 - $550,000$550,001 - $575,000$575,001 - $600,000$600,001 - $625,000$625,001 - $650,000$650,001 - $675,000$675,001 - $700,000$700,001 - $725,000$725,001 - $750,000$750,001 - $775,000$775,001 - $800,000$800,001 - $825,000$825,001 - $850,000$850,001 - $875,000$875,001 - $900,000$900,001 - $925,000$925,001 - $950,000$950,001 - $975,000$975,001 - $1,000,000$1,000,001 - $1,100,000$1,100,001 - $1,200,000$1,200,001 - $1,300,000$1,300,001 - $1,400,000$1,400,001 - $1,500,000$1,500,000+ Estimate your current interest rate: Select an optionLess than 2.00%2.00%2.25%2.50%2.75%3.00%3.25%3.50%3.75%4.00%4.25%4.50%4.75%5.00%5.25%5.50%5.75%6.00%6.25%6.50%6.75%7.00%7.25%7.50%7.75%8.00%8.25%8.50%8.75%9.00%9.25%9.50%9.75%10.00%10.25%10.50%10.75%11.00%11.25%11.50%11.75%12.00% How long do you plan on keeping the property: Select an optionLess than a year1 - 5 years6 - 10 years11 - 15 years21 - 25 years26 - 30 years30+ years Estimate your current loan balance? Select an optionLess than $100,000$100,001 - $110,000$110,001 - $120,000$120,001 - $130,000$130,001 - $140,000$140,001 - $150,000$150,001 - $160,000$160,001 - $170,000$170,001 - $180,000$180,001 - $190,000$190,001 - $200,000$200,001 - $210,000$220,001 - $230,000$230,001 - $240,000$240,001 - $250,000$250,001 - $275,000$275,001 - $300,000$300,001 - $325,000$325,001 - $350,000$350,001 - $375,000$375,001 - $400,000$400,001 - $425,000$425,001 - $450,000$450,001 - $475,000$475,001 - $500,000$525,001 - $550,000$550,001 - $575,000$575,001 - $600,000$600,001 - $625,000$625,001 - $650,000$650,001 - $675,000$675,001 - $700,000$700,001 - $725,000$725,001 - $750,000$750,001 - $775,000$775,001 - $800,000$800,001 - $825,000$825,001 - $850,000$850,001 - $875,000$875,001 - $900,000$900,001 - $925,000$925,001 - $950,000$950,001 - $975,000$975,001 - $1,000,000$1,000,001 - $1,100,000$1,100,001 - $1,200,000$1,200,001 - $1,300,000$1,300,001 - $1,400,000$1,400,001 - $1,500,000$1,500,000+ What is your current loan program? Select an optionFixedAdjustableOptionOtherNot Sure BACKNEXT Are you the primary borrower?YESNO Is there a co-borrower?YESNO What is the employment status of the primary borrower? Select an optionFull TimePart TimeSelf-EmployedStudentRetiredOther Estimate your average monthly expenses: Select an optionLess than $1,000$1,001 - $2,000$2,001 - $3,000$3,001 - $5,000$7,001 - $10,000$10,001 - $12,500$12,501 - $16,000$16,001 - $20,000$20,001 - $25,000$25,001 - $30,000$30,000+ Do you know your credit score? YESNO Has the primary or co-borrower filed for bankruptcy in the last seven years? YESNO BACKNEXT First Name : Last Name : Phone # : Email Address : BACK