* First Name:  * Last Name:  Telephone:  * Email Address:  Street Address:  City:  State:  Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland-Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Zip Code:  Is this request for a: Purchase Loan (please fill out part 2 only) Refinance Loan Home Equity Line of Credit (HELOC) What would you like to refinance? Refinance 1st mortgage only Refinance 2nd Mortgage only Refinance 1st and 2nd together What else would you like to accomplish? Cash out, explain: Bill Consolidation Home Improvement, explain: Reduce the term of your mortgage Other: When did you purchase your home? What is your home valued at? What year term are you looking for? How much do you own on: 1st mtg: 2nd mtg: HELOC: What is your current interest rate? % Is this an Adjustable Rate or Balloon loan? Y N What is your monthly house payment on: 1st mtg: 2nd mtg: HELOC: Does your pmt. include taxes and insurance? Y N Any late payments on your mortgage in the last year? Y N What kind of property type is this loan for? Single Family Residence (SFR) Duplex (2-4 unit) or Condo Townhouse Manufactured Home Is this property your primary residence? Y N Purchase price (Purchases only)? $ Down payment amount: $ Is your down payment seasoned for 60 days or more? Y N Is any of your down payment borrowed? Y N What type of loan are you interested in? What kind of year term would you like? years Is this loan contingent upon you selling another home? Y N Is this going to be your primary residence? Y N What kind of property type is this loan for? Single Family Residence Manufactured Home Townhouse Duplex (2-4 unit) or Condo Do you own any other real estate? Y N Are you currently renting? Y N Have you been more than 29+ days late on rent pmt? Y N When is the closing date scheduled for? Borrower Name: Co-Borrower Name: Current Address: What is the monthly household gross income? $/mo Please estimate your credit history: Excellent (no late pmts, established credit lines) Some Problems (some late pmts on cc's, no mortgage lates over 30 days, no Bankruptcy, no foreclosure) Major Problems (Bankruptcy, collections, several late pmts, and/or mortgage late pmts over 30 days) How long have you been on your current job? Are you self employed? Y N What is the best time to contact you? (indicate AM / PM) What is the best number to reach you at? Select the statement that best describes what you need: I need a loan, and I need it now! I am working with another lender but have not locked my rate yet, and I am interested in ABSOLUTE Mortgage. I have already locked in with another lender, but I am researching other options. * required field