Mortgage Company: _____________________________ Confirmed: ______________________________

Date: ___________ Time: _____________ T.M: ____________ A.K.A ____________________________

Borrower: ___________________________         Co- Borrower_______________________________________

Spoke to: ____________________________ Phone Number: ____________________________________

Address: ____________________________ Day Time: _________________________________________

City: _______________________ State: ________________ Zip Code: ____________________________

Current Mortgage Balance: ____________________ 2^nd Mortgage Balance: ________________________

1^st Mtg. Term ______________ years 1^st Mtg. Rate _____________ Fixed / Adj. / ARM / 2 / 3 / 5 / 7 years        

2^nd Mtg. Term _____________ years 2^nd Mtg. Rate _____________ Fixed / Adj. / ARM / 2 / 3 / 5 / 7 years        

If on an ARM, when is the ARM up? _____________________

Original Purchase Price: ____________________ Year Owned: ___________________ years

Present Home Value: ____________ Is that estimated Owner / Appraisal: Date ___________________

Do you currently have a pre-payment penalty: YES / NO If yes, for how long is t for? _____________

Type of home: Single family /Condo / Townhouse / 1 2 3 4 Unit / Double Wide / Manufactured Home   

Monthly Mortgage Payment _______ 2^nd Mortgage Payment ________ Taxes & Ins. Included? YES / NO          

Would you be interested indebt consolidation? YES / NO         Revolving Debt: ______________________

Any Cash for Home Improvement? YES / NO         Total Amount of Cash Needed: _________________

How would you describe your credit history? Excellent / Above Average / Average / Bellow Average

Have you had any auto, mortgage, or credit card payments more than 30 days late in the past 12 months?

                YES / NO More than 60 days: YES / NO More than 90 days: YES / NO

Have you had a previous bankruptcy: YES / NO    Chapter 7 or 13: _____ Discharge Date: __________

Place of employment: ________________________________________ How long: __________________

Gross Yearly Income: _________________________

Co-Borrower place of employment: _____________________________ How long: __________________

Gross Yearly Income: _________________________

Have you been working with any other mortgage companies? YES / NO If yes what company: __________

When is the last time you refinanced? __________________________________

FICO SCORE: (Located on right hand of call sheets ______________________

What are you more interested in: Refinance for lower rate or cash back for debt consolidation or home improvement? __________________________

Email address (optional) __________________

Notes: ________________________________________________________________________________

Call Back Time: ______________ : ______________ AM / PM DATE OF CALL BACK: ___