* 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

Submit Application

Dacia J. Welch
Coldwell Banker
5 Moraga Way
Orinda, CA 94563
(925) 323-4470 cell
(925) 253-0416 fax
DaciaVous@comcast.net