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Type of Financing You Need
*	What is the type of loan you desire?
	Mortgage Second Mortgage Refinance Construction       Other: (i.e. new or custom home)
*	When do you anticipate purchasing?
	-- Select One -- 1 Month or Less 1-3 Months 3-6 Months 6-12 Months 1 Year or Greater
*	Are you currently working with a lender?
	Yes  No
*	What is your total budget for this purchase?
	-- Select One -- $100,000 - $250,000 $250,000 - $500,000 $500,000 - $750,000 $750,000 - $1,000,000 $1,000,000 - $2,500,000 $2,500,000 - $5,000,000 $5,000,000 And Above Unsure
*	I am making this request because:
	-- Select One -- This is a new need and I welcome advice I want to replace my current lender I have a quote and am looking for a comparison Other (See Details Field)
*	How is your credit history?
	-- Select One -- ExcellentGood FairPoor Not Sure
*	Details:  (explain above answers if necessary)

Your Contact Information
*	I would like to receive responses at this email address:
	Your Name and Location where work to take place

*

Where do you need this product or service? ZIP/Postal Code:   - OR -  City & State/Province:   -- Select One --Alabama AlaskaAlbertaAmerican SomoaArizonaArkansas British ColumbiaCalifornia Caroline IslandsColorado ConnecticutDelaware District of ColumbiaFlorida GeorgiaGuamHawaii IdahoIllinoisIndiana IowaKansasKentucky LouisianaMaineManitoba Mariana IslandsMarshall Islands MarylandMassachusetts MichiganMinnesota MississippiMissouri MontanaNebraskaNevada New BrunswickNew Foundland New HampshireNew Jersey New MexicoNew York North CarolinaNorth Dakota NorthWest TerritoriesNova Scotia OhioOklahomaOntario OregonPennsylvania Prince Edward IslandPuerto Rico PalauQuebecRhode IslandSaskatchewan South CarolinaSouth Dakota TennesseeTexasUtah VermontVirgin Islands VirginiaWashingtonWest VirginiaWisconsin WyomingYukon Territory

*	First Name:    Last Name:

*	Phone Number: ()     Best Time to Call (Daytime Preferred): -- Select One -- Morning Afternoon Evening Weekend No Preference

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Click here to download a full 1003 that can be printed out and faxed or mailed back to me.

Greg Hartle
Mortgage Consultant
KMG Financial
355 W. Mesquite Blvd, Suite C-100
Mesquite, Nevada 89027     Toll Free Fax:  866.409.1959

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