MIE FInancial, Inc. Ph: 847-514-2079 Fax: 847-890-6035
	Refinance Purchase | Equity Line of Credit   About Your Loan Program Loan Program Loan Purpose 30 Year Fixed 15 Year Fixed 5 Yr Balloon 7 Yr Balloon 1/1 ARM 3/1 ARM 5/1 ARM 7/1 ARM VA 30 Yr FHA 30 Yr FHA ARM Other/See Comments Rate/Term Refinance Cash-Out Refi No Cash-Out Refi Second Mortgage Home Improvement Debt Consolidation Other/See Comments Loan Amount ($) * Property Value ($) * Estimated Timeframe < 30 Days 30-60 Days 60-90 Days Not Sure 120 Property Information Property Type - Single family Condo Commercial Investment Co-op Mobile Home Multi Family Address * City *             State Zip * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Refinance Information 1st Mortgage Balance($) 1st Mortgage Payment($) 1st Mortgage Rate % 2nd Mortgage Balance($) 2nd Mortgage Payment($) 2nd Mortgage Rate % Borrower Information First Name * Last Name * Social Security Number - - Daytime Phone * Evening Phone * Email Employment Information Self Employed Years Employed Annual Income($) no yes 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Income and Expense Information Monthly Expenses($) Credit History Excellent Good Fair Poor How did you hear about us? ----Select------ News paper TV/Radio Flyer Search Engine Other Comments

3621 Old Buffalo Grove Rd, Arlington Heights, IL 60004 Tel:847-652-0783 Fax:847-890-6035
loan@miefinancial.com

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