Applicant Information                                       

  First Name

Last Name

E-Mail

Phone

 Best Time to be Contacted

                                       First Mortgage Information                                  

  Current Value of Home    Don't Know?

Mortgage Balance

Interest Rate

Remaining Years to Payoff

Total Monthly Payment

Monthly Amount Paid to Escrow

Loan Type

                                   Second Mortgage Information                                

  2nd Mortgage Balance

Interest Rate

Remaining Years to Payoff

Monthly Payment

Loan Type

                                            Income Information                                         

  Earner #1 Net ANNUAL Income (after taxes, etc)

Earner #1 Payment Schedule

Earner #1 Income Type

Earner #1 FICO     Don't Know?

Earner #2 Net ANNUAL Income (after taxes, etc)

Earner #2 Payment Schedule

Earner #2 Income Type

Earner #2 FICO     Don't Know?

                                           Discretionary Income                                        

    Money left over each month after paying expenses
  (credit, entertainment, utilities, etc.)

                                          Additional Information                                       

   Additional Creditors (Auto, Credit Card, etc.) — you may group Credit Card            
    obligations together.  Be sure to include Credit Type (vehicle, credit card, etc),
    balance owing, monthly payment, interest rate and years remaining.
  

NOTICE: By completing the fields on this web page you are allowing us to confirm the potential benefits under Money Merge Account™ guidelines for term and interest reduction with no obligation on your part to purchase Money Merge Account™ software or on our part to offer the Money Merge Account™ program.