* Required Fields Borrower Information

First Name* Last Name* Home Phone Work Phone

Address Email*

City State Zip Borrower's Current Employer

Gross Monthly Income Are You Self Employed   Select One Yes No

Co-Borrower Information

YesNo

First Name* Last Name* Home Phone Work Phone

Address Email*

City State Zip Co-Borrower's Current Employer

Gross Monthly Income Are You Self Employed   Select One Yes No

Mortgage Information

Loan Purpose Loan Type Select One Construct Home Rate/Term - Refinance Cash Out - Refinance Home Improvement Debt Consolidation Change Loan Type-Refi Const. to Perm. Purchase Other   Select One 30 Year Conventional 15 Year Conventional 30 Year FHA Fixed 30 Year VA Loan 1 Year Arm 3/1 Year Arm 5/1 Year Arm 5 Year Balloon 7 Year Balloon FHA Arm Other Loan

Amortization Type Estimated Closing Time Select One Fixed Rate ARM GPM Other   Select One Immediately Within 1 month Within 2 months More than 3 months

Loan Amount Amount Of Existing Loans

Property Information

Address Property Will Be   Select One Primary Residence Secondary Residence Investment

City State Zip Purchase Price Est. Value if Refinancing

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Jennie A. Flanigan
Pacific Union - Montclair
1900 Mountain Blvd.
Oakland, CA  94611
(510) 338-1354 Office
(510) 610-3601 Mobile
(510) 339-6519 Fax
JFlanigan@PacUnion.com