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Contact Information Applicant Name First Name • Middle Initial • Last Name Social Security Number (xxx-xx-xxxx)     Co-Applicant Name First Name • Middle Initial • Last Name Social Security Number (xxx-xx-xxxx) Do you currently: Own a Home Rent Your Date of Birth    Current Street Address    City • State      - Please select - AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code    Home Phone    (xxx-xxx-xxxx) Work Phone    (xxx-xxx-xxxx) Mobile Phone / Pager    (xxx-xxx-xxxx) Best time to contact you?    - Please select - Morning at Home Morning at Work Morning at Mobile Afternoon at Home Afternoon at Work Afternoon at Mobile Evening at Home Evening at Work Evening at Mobile Email Address    Property Details Property Type    - Please select - Single Family Residence Condominium Town House Investment Property Purchase Price    Year Property was Acquired    Present Value of Property    Existing First Mortgage Details (if applicable) Amount Owed on First Mortgage    Current Interest Rate    Loan Type     Fixed       Adjustable Monthly Payment    Existing Second Mortgage Details (if applicable) Amount Owed on Second Mortgage    Current Interest Rate    Loan Type     Fixed       Adjustable Monthly Payment    Preferences Type of Loan Desired    - Please select - Debt Consolidation Refinance Home Improvement Home Equity Line of Credit Refinance with Cash Out Purchase Loan Amount Desired    Please describe your current loan needs:  I am very interested and ready to work with a lender. I am currently working with a lender, but am looking at other options. I would like a personalized rate quote detailing my loan options. I am interested in seeing multiple loan programs that apply to my situation. How did you find FSMortg.com?    - Please select - Banner ad Search engine Print advertising Radio Commercial Word of mouth / Referral Other Employment/Income Information - Primary Applicant - Current Employer Name    Years with Current Employer    Yearly Income    How would you rate your credit?    Excellent  Good  Fair  Poor - Co-Applicant (if applicable) - Current Employer Name    Years with Current Employer    Yearly Income    How would you rate your credit?    Excellent  Good  Fair  Poor Additional Comments Please include anything you feel might be helpful to us in consideration of your application:  * By completing this application and providing my SSN I hereby authorize First Solution Mortgage to obtain my Credit Report. I understand this is required in order to provide me with the best loan that matches my unique needs. Privacy Policy Information provided to fsmortg.com is not shared with any entities or parties who are not specifically in the business of providing mortgage loans to consumers. Your information will not be sold, shared or otherwise distributed to anyone other than banking, financial and/or lending institutions, and specifically for the purpose of obtaining a mortgage loan that suits your needs. We understand and value the need for privacy with financial and personal information, and guard such data with the utmost care.

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