Confidential Information Request

When you complete this form you agree to be contacted only by UXP Mortgage Corp. for the sole purpose of helping you to find the absolute best mortgage available.  Your information is used only to help obtain your loan and will not be shared with anyone for any other purpose, we know you have many choices and appreciate your confidence. (see privacy policy)

Just take 2 minutes to fill out our secure confidential information request  below.  You will be contacted within 2 to 24 hours, or possibly sooner by one of our licensed professional mortgage consultants to go over your options at no cost or obligation.

information in red is required, and estimates are OK

LOAN REQUEST
What kind of loan would you like:		choose one refinance my 1st mortgage refinance my 2nd mortgage only refinance my 1st and 2nd into new loan a new second mortgage purchase a home
How much would you like to borrow:		$ --choose closest-- $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $55,000 $60,000 $65,000 $70,000 $75,000 $80,000 $85,000 $90,000 $95,000 $100,000 $105,000 $110,000 $115,000 $120,000 $125,000 $130,000 $135,000 $140,000 $145,000 $150,000 $155,000 $160,000 $165,000 $170,000 $175,000 $180,000 $185,000 $190,000 $195,000 $200,000 $205,000 $210,000 $215,000 $220,000 $225,000 $230,000 $235,000 $240,000 $245,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $475,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,600,000 $1,700,000 $1,800,000 $1,900,000 Over $2,000,000
BORROWER INFO
Name: (first, last)
Home phone:		(000) 000-0000
Email address:
Work phone: (if applicable)		(000) 000-0000 ext123
Please rate your credit:		choose one excellent good fair poor bankruptcy or forclosure
Best person to contact:		either borrower borrower co-borrower
Best time to call:		anytime 8:00 to 10:00 AM 10:00 AM to 12:00 PM 12:00 to 2:00 PM 2:00 to 4:00 PM 4:00 to 6:00 PM 6:00 to 8:00 PM
CO-BORROWER INFO
Name: (first, last)
Email address:
Work phone:		(000) 000-0000 ext123
PROPERTY INFO
State:		--choose state-- value=AL>Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennesse Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Home value: (estimate ok)		$ --choose closest-- option value="75000">$75,000 $80,000 $85,000 $90,000 $95,000 $100,000 $105,000 $110,000 $115,000 $120,000 $125,000 $130,000 $135,000 $140,000 $145,000 $150,000 $155,000 $160,000 $165,000 $170,000 $175,000 $180,000 $185,000 $190,000 $195,000 $200,000 $205,000 $210,000 $215,000 $220,000 $225,000 $230,000 $235,000 $240,000 $245,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $475,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,600,000 $1,700,000 $1,800,000 $1,900,000 Over $2,000,000
CURRENT LOAN INFO
First mortgage balance:		$ --choose closest-- $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $55,000 $60,000 $65,000 $70,000 $75,000 $80,000 $85,000 $90,000 $95,000 $100,000 $105,000 $110,000 $115,000 $120,000 $125,000 $130,000 $135,000 $140,000 $145,000 $150,000 $155,000 $160,000 $165,000 $170,000 $175,000 $180,000 $185,000 $190,000 $195,000 $200,000 $205,000 $210,000 $215,000 $220,000 $225,000 $230,000 $235,000 $240,000 $245,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $475,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,600,000 $1,700,000 $1,800,000 $1,900,000 Over $2,000,000
First mortgage payment:		$
Do you have a second mortgage?		yes      no
Second mortgage balance: (if applicable)		$ --choose closest-- not applicable $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 $55,000 $60,000 $65,000 $70,000 $75,000 $80,000 $85,000 $90,000 $95,000 $100,000 $105,000 $110,000 $115,000 $120,000 $125,000 $130,000 $135,000 $140,000 $145,000 $150,000 $155,000 $160,000 $165,000 $170,000 $175,000 $180,000 $185,000 $190,000 $195,000 $200,000 $205,000 $210,000 $215,000 $220,000 $225,000 $230,000 $235,000 $240,000 $245,000 $250,000 $275,000 $300,000 $325,000 $350,000 $375,000 $400,000 $425,000 $475,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 $1,100,000 $1,200,000 $1,300,000 $1,400,000 $1,500,000 $1,600,000 $1,700,000 $1,800,000 $1,900,000 Over $2,000,000
Second mortgage payment: (if applicable)		$
CURRENT LOAN NEEDS
I'm ready to start the application process:
I'm interested in working with a competitive lender:
I am just checking rates to see if a loan makes sense:
I am only interested in rates and am not looking for a loan at this time:
COMMENTS