Metro Atlanta Mortgage Company, Inc.

Refinancing Form

Is my information safe?

Preferred Loan Officer (if applicable):

Primary Borrower's Contact Information:

First Name: Last Name: Middle Initial:

Current Home Address:

City: State: ZIP:

Home Phone: Cell Phone: Work Phone

() - () - () -

E-Mail:

Work: Personal:

Co-Borrower's Contact Information (if applicable):

First Name: Last Name: Middle Initial:

Current Home Address:

City: State: ZIP:

Home Phone: Cell Phone: Work Phone

() - () - () -

E-Mail:

Work: Personal:

Form Specific Information:

**We can only be as accurate as the information that you provide to us. Please respond to as many of the following questions as possible.**

Address of Property to be Refinanced
(If different than Current Home Address):

City: State: ZIP:

1st Mortgage Principle Balance: Payment: Current Rate:

$ $ %

Does your payment include your taxes and insurance? Yes No

2nd Mortgage Principle Balance
(if applicable): Payment: Current Rate:

$ $ %

2006 Annual Property Tax: Yearly Insurance: Current Payment:

$ $ $

Approx. Appraised Value of Property:

$

Has your property been listed in the last 6 months? Yes No

Are you seeking cash back? Yes No

If so, how much? $

Additional Comments: