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Debt Consolidation Advice Request

Please fill in this form as completely as possible in order to ensure proper rating for your submission.

First we need to know about the type of property the consumer is looking for a debt consolidation loan on:

What type of residence will you be debt consolidation loan on is:

The home I'd like to debt consolidation loan is:
 

I currently have the following type of federal loan:
 

I currently qualify for the following type of federal loan:
 

Are you interested in a no-document loan?
 

I would like to find this loan in the next:
 

Next we need to know about the consumers current mortgage:

What term of loan are you looking for?
 

Your current mortgage monthly payment:
$

Current mortgage interest rate:
 %

Do you need any cash back for anything  If so, how much
$

How much is your home currently worth:
$

Your home's original sale price:
$

How long have you owned your home:
 years

Your current mortgage balance:
$

Do you have a 2nd home loan?
 

2nd mortgage balance:
$

2nd mortgage monthly payment:
$

2nd mortgage interest rate:
 %

Finally we need to know about the consumer

Are you self-employed?
 

If no, how long have you been with your employer:
 years

What type of loan do you want?
 

How is your credit?
 

How much do you gross each month:
$

How much do you owe each month:
$

E-mail Address:
 

Best time for a licensed professional to call?
 

First Name:
 

Have you thought of selling your home?
 

Last Name:
 

If yes, what is your time frame for selling?
 

Address Line 1:
 

Would you like a real estate broker to call you and explain your options?
 

Address Line 2: (Apt. #, Suite #, etc.)
 

Would you like to submit an additional rate request for this individual?  If so what type?

 Life Insurance
 Annuity (Retirement Vehicle)
 Long Term Care Insurance
 Disability Income Insurance
 Health Insurance
 Group Health Insurance
 Homeowners Insurance
 Auto Insurance

City:
 

State:
 

Zip Code:
 

Day Phone:
     

Eve Phone:
     

 
Rapid Rates
info@rapidrates.com
59 Dean Street, Hicksville, New York, 11801
Toll Free 888-31-RATES  Fax:  801-515-7597

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