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Refinance Lead Form
Brian Lardner
2021-05-04T01:17:52+00:00
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Property Use
*
Principal Residence
2nd Home
Investment
Loan Type
*
Single Family
2-4 Units
Estimated home value
*
Loan Purpose
*
Refinance-No Cash Out
Refinance-Cash Out
Purchase
1st mortgage balance
*
1st mortgage interest rate
*
Mortgage lates in the past 12 months
*
Any bankruptcy in the past 3 years
*
Yes
No
Currently in an FHA loan
*
Yes
No
Additional cash
Name
*
First name
last name
Email
*
Phone number
*
Subject
*
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have a 2nd mortgage
*
Yes
No
What year was property purchased ?
Credit
*
Normal
Good
Excellent
First mortgage holder
*
Existing rate type
*
Fixed
Variable
Ever Refinance Before
*
Yes
No
Employment status
*
Employed
Self-Employed
Retired
Phone
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