Name:
Phone: --
Email:
Subject:
Notes /
Questions:
 
  Debt Analysis - Please fill-in the following form:
1. Full Legal Name: 
2. Address: 
3. City:   State:   ZIP:   
4. Email: 
5. Phone: --
6. 1st Mortgage Balance: 
7. Current Interest Rate: 
8. Monthly Payment: 
9. Taxes/Insurance Included? 
10. Approximately how much are your taxes/year? 
11. Approximately how much is your insurance/year? 
12. 2nd Mortgage Balance: 
13. Current Interest Rate: 
14. Monthly Payment: 
15. Amount of debt you would like to consolidate: 
16. Current monthly payments for this debt amount: 
17. Approximate average interest rate on this debt: 
18. What is the annual pre-tax income of all Borrowers on the loan? 
19. Have you been at your job or in the same line of work for at least 2 years? 
20. How much is your home worth? 
Would you like us to find out for you? Just provide the following:
1. Home style: 
2. Bedrooms: 
3. Bathrooms: 
4. Square Footage: 
5. Garage: 
6. Basement: 
7. Any Acreage: 
8. Age of your home: 
 
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