Prequalification & Cost vs. Benefit Analysis Questionnare

When calling, faxing, or mailing us, please be prepared with the information listed below

You can either print this form, fill-in the information, then fax/mail it to us, or type in the information and send the completed form electronically (see below).

Conservative estimate of the value of your home:	$
Type of property: (e.g. single, condo, townhouse, duplex, investment, second home)
Monthly association fees: (if property is in a condo or PUD - Planned Unit Development)	$
How much longer do you envision yourself remaining in and/or owning the property?
Annual Property Taxes : You can locate this information by either calling your existing mortgage servicer, looking at your most recent escrow analysis statement (by law, you are supposed to receive this once a year if you have an escrow account), or by looking at your most recent 1999-2000 school, county, and/or township tax bills (if you don't have an escrow account).	$
Annual Hazard/Homeowner's Insurance:	$
Monthly Mortgage Insurance Payment: If you put less than 20% down when you bought your home, you probably are still paying mortgage insurance. To locate this information, you can either look at your most recent bill, call your existing mortgage servicer, or look at your most recent escrow analysis statement.	$

1st Mortgage:

Balance:
$ Interest Rate:
Original Loan Amount:
$

Original Amortization/Term:

(e.g. 30 yrs, 15 yrs, etc) Date Settled:

(month/year) Loan Type:

(e.g. fixed or adjustable)

2nd Mortgage and/or other liens:
(if applicable)

Balance:
$ Interest Rate:
Original Loan Amount:
$

Original Amortization/Term:

(e.g. 30 yrs, 15 yrs, etc) Date Settled:

(month/year) Loan Type:

(e.g. fixed or adjustable)

For Cash-Out Customers Only:

Amount Needed:
$

When needed?

Personal Information:

Your Name:
Your Work Phone Number:

This is not for solicitation purposes -
only for possible further needed information
Your Home Phone Number:

How would you like to be contacted with the results?

After completing this form, you can either print it and mail/fax it to PMC, or you may electronically submit this information directly to our server. All your information will be kept confidential and will not be released to non-authorized personnel. If you wish to electronically submit this form, please click on the "Submit" button below when you are finished completing the form.

By submitting this form with your telephone number you are consenting for Laurence Ostrom and all authorized representatives to contact you even if your name is on a Federal or State "Do not call List."

Balance: $	Interest Rate:	Original Loan Amount: $
Original Amortization/Term: (e.g. 30 yrs, 15 yrs, etc)	Date Settled: (month/year)	Loan Type: (e.g. fixed or adjustable)

Balance: $	Interest Rate:	Original Loan Amount: $
Original Amortization/Term: (e.g. 30 yrs, 15 yrs, etc)	Date Settled: (month/year)	Loan Type: (e.g. fixed or adjustable)

Your Name:	Your Work Phone Number:
This is not for solicitation purposes - only for possible further needed information	Your Home Phone Number: