Estimated Home Value Select One $80,000 - $85,000 $85,000 - $90,000 $90,000 - $95,000 $95,000 - $100,000 $100,000 - $105,000 $105,000 - $110,000 $110,000 - $115,000 $115,000 - $120,000 $120,000 - $125,000 $125,000 - $130,000 $130,000 - $135,000 $135,000 - $140,000 $140,000 - $145,000 $145,000 - $150,000 $150,000 - $155,000 $155,000 - $160,000 $160,000 - $165,000 $165,000 - $170,000 $170,000 - $175,000 $175,000 - $180,000 $180,000 - $185,000 $185,000 - $190,000 $190,000 - $195,000 $195,000 - $200,000 $200,000 - $210,000 $210,000 - $220,000 $220,000 - $230,000 $230,000 - $240,000 $240,000 - $250,000 $250,000 - $260,000 $260,000 - $270,000 $270,000 - $280,000 $280,000 - $290,000 $290,000 - $300,000 $300,000 - $310,000 $310,000 - $320,000 $320,000 - $330,000 $330,000 - $340,000 $340,000 - $350,000 $350,000 - $360,000 $360,000 - $370,000 $370,000 - $380,000 $380,000 - $390,000 $390,000 - $400,000 $400,000 - $420,000 $420,000 - $440,000 $440,000 - $460,000 $460,000 - $480,000 $480,000 - $500,000 $500,000 - $520,000 $520,000 - $540,000 $540,000 - $560,000 $560,000 - $580,000 $580,000 - $600,000 $600,000 - $620,000 $620,000 - $640,000 $640,000 - $660,000 $660,000 - $680,000 $680,000 - $700,000 $700,000 - $720,000 $720,000 - $740,000 $740,000 - $760,000 $760,000 - $780,000 $780,000 - $800,000 $800,000 - $820,000 $820,000 - $840,000 $840,000 - $860,000 $860,000 - $880,000 $880,000 - $900,000 $900,000 - $920,000 $920,000 - $940,000 $940,000 - $960,000 $960,000 - $980,000 $980,001 - $1,000,000 $1,000,000+ $1,500,000+ $2,000,000+ OK to estimate

1st Mortgage Balance Select One $50,000 - $55,000 $55,000 - $60,000 $60,000 - $65,000 $65,000 - $70,000 $70,000 - $75,000 $75,000 - $80,000 $80,000 - $85,000 $85,000 - $90,000 $90,000 - $95,000 $95,000 - $100,000 $100,000 - $105,000 $105,000 - $110,000 $110,000 - $115,000 $115,000 - $120,000 $120,000 - $125,000 $125,000 - $130,000 $130,000 - $135,000 $135,000 - $140,000 $140,000 - $145,000 $145,000 - $150,000 $150,000 - $155,000 $155,000 - $160,000 $160,000 - $165,000 $165,000 - $170,000 $170,000 - $175,000 $175,000 - $180,000 $180,000 - $185,000 $185,000 - $190,000 $190,000 - $195,000 $195,000 - $200,000 $200,000 - $210,000 $210,000 - $220,000 $220,000 - $230,000 $230,000 - $240,000 $240,000 - $250,000 $250,000 - $260,000 $260,000 - $270,000 $270,000 - $280,000 $280,000 - $290,000 $290,000 - $300,000 $300,000 - $310,000 $310,000 - $320,000 $320,000 - $330,000 $330,000 - $340,000 $340,000 - $350,000 $350,000 - $360,000 $360,000 - $370,000 $370,000 - $380,000 $380,000 - $390,000 $390,000 - $400,000 $400,000 - $420,000 $420,000 - $440,000 $440,000 - $460,000 $460,000 - $480,000 $480,000 - $500,000 $500,000 - $520,000 $520,000 - $540,000 $540,000 - $560,000 $560,000 - $580,000 $580,000 - $600,000 $600,000 - $620,000 $620,000 - $640,000 $640,000 - $660,000 $660,000 - $680,000 $680,000 - $700,000 $700,000 - $720,000 $720,000 - $740,000 $740,000 - $760,000 $760,000 - $780,000 $780,000 - $800,000 $800,000 - $820,000 $820,000 - $840,000 $840,000 - $860,000 $860,000 - $880,000 $880,000 - $900,000 $900,000 - $920,000 $920,000 - $940,000 $940,000 - $960,000 $960,000 - $980,000 $980,001 - $1,000,000 $1,000,000+ $1,500,000+ $2,000,000+ OK to estimate

Do you have a 2nd Mortgage? Yes No

How much additional cash do you wish to borrow? Select One 0 $0 - $5,000 $5,000 - $10,000 $10,000 - $15,000 $15,000 - $20,000 $20,000 - $25,000 $25,000 - $30,000 $30,000 - $35,000 $35,000 - $40,000 $40,000 - $45,000 $45,000 - $50,000 $50,000 - $55,000 $55,000 - $60,000 $60,000 - $65,000 $65,000 - $70,000 $70,000 - $75,000 $75,000 - $80,000 $80,000 - $85,000 $85,000 - $90,000 $90,000 - $95,000 $95,000 - $100,000 $100,000 - $105,000 $105,000 - $110,000 $110,000 - $115,000 $115,000 - $120,000 $120,000 - $125,000 $125,000 - $130,000 $130,000 - $135,000 $135,000 - $140,000 $140,000 - $145,000 $145,000 - $150,000 $150,000 - $155,000 $155,000 - $160,000 $160,000 - $165,000 $165,000 - $170,000 $170,000 - $175,000 $175,000 - $180,000 $180,000 - $185,000 $185,000 - $190,000 $190,000 - $195,000 $195,000 - $200,000 $200,000 - $210,000 $210,000 - $220,000 $220,000 - $230,000 $230,000 - $240,000 $240,000 - $250,000 $250,000 - $260,000 $260,000 - $270,000 $270,000 - $280,000 $280,000 - $290,000 $290,000 - $300,000 $300,000 - $310,000 $310,000 - $320,000 $320,000 - $330,000 $330,000 - $340,000 $340,000 - $350,000 $350,000 - $360,000 $360,000 - $370,000 $370,000 - $380,000 $380,000 - $390,000 $390,000 - $400,000 $400,000 - $420,000 $420,000 - $440,000 $440,000 - $460,000 $460,000 - $480,000 $480,000 - $500,000 $500,000 - $520,000 $520,000 - $540,000 $540,000 - $560,000 $560,000 - $580,000 $580,000 - $600,000 $600,000 - $620,000 $620,000 - $640,000 $640,000 - $660,000 $660,000 - $680,000 $680,000 - $700,000 $700,000 - $720,000 $720,000 - $740,000 $740,000 - $760,000 $760,000 - $780,000 $780,000 - $800,000 $800,000 - $820,000 $820,000 - $840,000 $840,000 - $860,000 $860,000 - $880,000 $880,000 - $900,000 $900,000 - $920,000 $920,000 - $940,000 $940,000 - $960,000 $960,000 - $980,000 $980,001 - $1,000,000 $1,000,000+ $1,500,000+ $2,000,000+ Do not include Mortgage Balances

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