143 Glenellen Rd West Roxbury, MA 02132 Phone: (516) 729-2732 Fax: (516) 505-5048 MA License #MB3607

Loan Request Form   Contact Information   Full Name Address City StateZIP   Phone Email   Property & Loan Information   StateCity Massacusetts New York     Property TypeOccupancy TypeCredit Single Family 2 Family 3-4 Family Condo Townhouse Coop Mixed Use     Owner Occupied 2nd Home Investment     Good Average  Bad Loan PurposeLoan Amount ($) Purchase Rate/Term Refinance Cash Out Refinance     Downpayment (%)Documentation Type     Full Income/Full Assets Stated Income/Full Assets Stated Income/Stated Assets No Docs Notes/Requests

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