1st Midwest Mortgage Corporation

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Purpose of Loan:

Purchase of a home I've identified

Purchase of home I'm looking for (pre-qualification)

Refinance

Construction

Home Equity

Amount Borrowing:

Estimated Down Payment (%):

Location of Property:

Street Address:

City:		State:		Zip:

Property Type:

Single Family

Condominium

Duplex

Multi-Unit

Purpose:

Primary Residence

Secondary Residence

Investment

Type of Loan Program:

Fixed

ARM

First-Time Buyers

Stated Income

Home Equity:

First Name:		Middle Initial:		Last Name:

Current Address:

Street Address:		State:		Zip:

Email:

Daytime Phone:		Evening Phone:

Best Time to Call:

Credit History:

Excellent

Okay, With Some Problems

Serious Credit Problems

Don't Know