Choose One Direct Mail Credit Union Radio Realtor Billboard Link Internet Search Other If other:

2. Borrowers Name:

*First:

Middle:

*Last:

Co-Borrowers Name:

First:

Middle:

Last:

3. Borrowers Numbers:

Social Security Number:

*Home Phone Number:

Work Phone Number:

Extension:

Co-Borrowers Numbers:

Social Security Number:

Home Phone Number:

Work Phone Number:

Extension:

4. Borrower Income and Debts:

Borrower Gross Monthly Income:
$
Are you able to document your income with paystubs, W-2's, tax returns? Y N

Borrower Total Minimum Monthly Repayment on all Debt (Auto, cards, student loans, etc). DO NOT include your house payment/rent or utilities:
$

Co-Borrower Income and Debts:

Co-Borrower Gross Monthly Income:
$
Are you able to document your income with paystubs, W-2's, tax returns? Y N

Co-Borrower Total Minimum Monthly Repayment on all Debt (Auto, cards, student loans, etc). DO NOT include your house payment/rent or utilities:
$

5. Your Home Address:

Street Address:

City:

State:

Zip:

6. Purpose of Loan:
Choose One Purchase a new property Refinance existing loan with no cash out Refinance existing loan plus cash Home Improvement Bill Consolidation

7. How Do You Plan to Use the Property?
Choose One Primary Residence Secondary Residence (vacation) Investment

8. Type of Property You Own or Plan to Buy?
Choose One Single Family Residence Townhouse/Condo Units

9. Value:

  If You Own - How Much is it Worth?
$
  If You Are Buying - At What Price?
$
  When are you planning to buy?
Choose One 1 to 3 months 3 to 6 months 6 to 12 months Don't Know

10. How Much Do You Want To Borrow Against Your Home (Purchase or Refinance):

  Loan Amount:
$

11. What Kind of Loan Do You Prefer?
Choose One 30 - year fix 15 - year fix Adjustable 5 year fixed 7 year fixed 10 year fixed

12. Your Savings

  Total Liquid funds available (savings, checking, 401K, stock, etc.):
$

12. How would you rate your credit?
Choose One Excellent Good Average Poor

13. Your Contact Information:

*E-Mail :

Fax Number :

14. Comments:

15. Comments about our Web Site:

I/We authorize Olympic Loan Center to obtain a preliminary credit report in connection with my loan pre-qualification.

Borrower(s): I agree.