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Loan Application (Fields Marked with * are required) Prefix:              Mr.Mrs.Mr. and Mrs.Miss.Dr. Name:        * Middle Name:   Last Name: * Address  * City:          * State    AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IsNorthwest TerritoriesNova ScotiaOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandProvince du QuebecPuerto RicoRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory* Zip Code:    * Home Phone:    Day Phone:  * Fax:               E-Mail:        * Length At Present Address: * Years  Months  Amount Owed on 1st / % Rate:   *  /  %* Amount Owed on 2nd / % Rate:   /   % Loan Type 1St / Loan Type 2nd:   FixedAdjustable*   /  FixedAdjustable Home Value:     * Yearly Income:    * Length of Current Employment:          *Years    *Months Are You Self Employed?  No Yes Credit Rating: Good (some lates)Excellent (no lates)Fair (collection)Poor (bankruptcy) Amount Requested: * What is the purpose of the loan?                                    c 2001, An independently owned and operated member of The Prudential Real Estate Affiliates, Inc