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solideo524

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solideo524@hotmail.com

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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<title>Fast Line Mortgage, Inc.</title>
<meta http-equiv="Content-Type" content="text/html; charset=euc-kr">
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<body bgcolor="#CCCCCC" leftmargin="10" topmargin="10" marginwidth="0" marginheight="0" onLoad="MM_preloadImages('home1.gif','program1.gif','contact1.gif','getloan1.gif','employment1.gif')">

<table width="750" border="0" cellpadding="0" cellspacing="0" bgcolor="#FFFFFF">
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  <tr>
    <td height="133" colspan="2" valign="top" bgcolor="#FFFFFF"><a href="index.htm"><img src="Logo.gif" width="212" height="133" border="0"></a></td>
    <td colspan="2" valign="top" bgcolor="#FFFFFF"><!--DWLayoutEmptyCell-->&nbsp;</td>
  </tr>
  <tr>
    <td height="20" colspan="4" valign="top"><table width="100%" border="0" cellpadding="0" cellspacing="0">
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  <tr>
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        <tr>
          <td width="750" height="16" valign="top" bgcolor="#666666"><div align="left"><font size="-1">January
              20, 2005 9:58 PM</font></div></td>
        </tr>
      </table></td>
  </tr>
  <tr>
    <td width="101" height="1047">&nbsp;</td>
    <td colspan="2" valign="top"><div align="justify">
        <p><font size="-1"> </font>
        <Form action="/wwwroot/cgi-bin/formmail.cgi"method="post">
          <table width="525" border="0" align="left" cellpadding="1" cellspacing="1">
            <tr>
              <td colspan="2"><div align="center"><font color="#0033CC" size="-1" face="Times New Roman, Times, serif">BORROWER
                  INFORMATION&nbsp;&nbsp;&nbsp;</font><font size="-1" face="Times New Roman, Times, serif">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<font color="#FF0000">&nbsp;*
                  indicates a required field</font></font></div></td>
            </tr>
            <tr>
              <td colspan="1" width="270" height="23"><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Loan Program Requested :</font></div></td>
              <td width="248"><div align="left"> <font size="-1">
                  <select name="Loan Program Requested" id="Loan Program Requested">
                    <option value="Select.....">Select ....</option>
                    <option value="Refinance Cash Out">Refinance Cash Out</option>
                    <option value="Refinance No Cash Out">Refinance No Cash Out</option>
                    <option value="Refinance Investment Property">Refinance Investment
                    Property</option>
                    <option value="Refinance Get Out of Foreclosure">Refinance
                    Get Out of Foreclosure</option>
                    <option value="Equity Loan Fixed Cash Out">Equity Loan Fixed
                    Cash Out</option>
                    <option value="Equity Loan Debt Consolidation">Equity Loan
                    Debt Consolidation</option>
                    <option value="Purchase Home">Purchase Home</option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td height="23"><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Loan Amount :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield2" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td> <div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  First Name :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield" type="text" value="" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Last Name :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield3" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Address : </font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield4" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  City :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield5" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  State :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <select name="select">
                    <option value="Select State">Select State</option>
                    <option value="AL">Alabama </option>
                    <option value="AK">Alaska </option>
                    <option value="AZ">Arizona </option>
                    <option value="AR">Arkansas </option>
                    <option value="CA">California </option>
                    <option value="CO">Colorado </option>
                    <option value="CT">Connecticut </option>
                    <option value="DC">District of Columbia </option>
                    <option value="DE">Delaware </option>
                    <option value="FL">Florida </option>
                    <option value="GA">Georgia </option>
                    <option value="HI">Hawaii </option>
                    <option value="IA">Iowa </option>
                    <option value="ID">Idaho </option>
                    <option value="IL">Illinois </option>
                    <option value="IN">Indiana </option>
                    <option value="KS">Kansas </option>
                    <option value="KY">Kentucky </option>
                    <option value="LA">Louisiana </option>
                    <option value="MA">Maine </option>
                    <option value="MD">Maryland </option>
                    <option value="ME">Massachusetts </option>
                    <option value="MI">Michigan </option>
                    <option value="MN">Minnesota </option>
                    <option value="MS">Mississippi </option>
                    <option value="MO">Missouri </option>
                    <option value="MT">Montana </option>
                    <option value="NE">Nebraska </option>
                    <option value="NV">Nevada </option>
                    <option value="NH">New Hampshire </option>
                    <option value="NJ">New Jersey </option>
                    <option value="NM">New Mexico </option>
                    <option value="NY">New York </option>
                    <option value="NC">North Carolina </option>
                    <option value="ND">North Dakota </option>
                    <option value="OH">Ohio </option>
                    <option value="OK">Oklahoma </option>
                    <option value="OR">Oregon </option>
                    <option value="PA">Pennsylvania </option>
                    <option value="RI">Rhode Island </option>
                    <option value="SC">South Carolina </option>
                    <option value="SD">South Dakota </option>
                    <option value="TN">Tennessee </option>
                    <option value="TX">Texas </option>
                    <option value="UT">Utah </option>
                    <option value="VT">Vermont </option>
                    <option value="VA">Virginia </option>
                    <option value="WA">Washington </option>
                    <option value="WV">West Virginia </option>
                    <option value="WI">Wisconsin </option>
                    <option value="WY">Wyoming </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Zip Code :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield6" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  E-mail :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield7" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Home Telephone Number :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield8" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Work Telephone Number :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield82" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Cell
                  Phone Number :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield83" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Employer Name :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield84" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Occupation :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield85" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Time on Job :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <select name="Year" id="Year">
                    <option value="Years ">Years </option>
                    <option value="1 Year ">1 Year </option>
                    <option value="2 Years ">2 Years </option>
                    <option value="3 Years ">3 Years </option>
                    <option value="4 Years ">4 Years </option>
                    <option value="5 Years ">5 Years </option>
                    <option value="6 Years ">6 Years </option>
                    <option value="7 Years ">7 Years </option>
                    <option value="8 Years ">8 Years </option>
                    <option value="9 Years ">9 Years </option>
                    <option value="10 Years ">10 Years </option>
                    <option value="11 Years ">11 Years </option>
                    <option value="12 Years ">12 Years </option>
                    <option value="13 Years ">13 Years </option>
                    <option value="14 Years ">14 Years </option>
                    <option value="15+ Years ">15+ Years </option>
                  </select>
                  <select name="Months1">
                    <option value="Months ">Months </option>
                    <option value="1 Month ">1 Month </option>
                    <option value="2 Months ">2 Months </option>
                    <option value="3 Months ">3 Months </option>
                    <option value="4 Months ">4 Months </option>
                    <option value="5 Months ">5 Months </option>
                    <option value="6 Months ">6 Months </option>
                    <option value="7 Months ">7 Months </option>
                    <option value="8 Months ">8 Months </option>
                    <option value="9 Months ">9 Months </option>
                    <option value="10 Months ">10 Months </option>
                    <option value="11 Months ">11 Months </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Monthly Gross Income :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <select name="MonthGross1">
                    <option value="Select ">Select </option>
                    <option value="Less than $500.00 ">Less than $500.00 </option>
                    <option value="$500 ">$500 </option>
                    <option value="$600 ">$600 </option>
                    <option value="$700 ">$700 </option>
                    <option value="$800 ">$800 </option>
                    <option value="$900 ">$900 </option>
                    <option value="$1000 ">$1000 </option>
                    <option value="$1,100 ">$1,100 </option>
                    <option value="$1,200 ">$1,200 </option>
                    <option value="$1,300 ">$1,300 </option>
                    <option value="$1,400 ">$1,400 </option>
                    <option value="$1,500 ">$1,500 </option>
                    <option value="$1,600 ">$1,600 </option>
                    <option value="$1,700 ">$1,700 </option>
                    <option value="$1,800 ">$1,800 </option>
                    <option value="$1,900 ">$1,900 </option>
                    <option value="$2,000 ">$2,000 </option>
                    <option value="$2,100 ">$2,100 </option>
                    <option value="$2,200 ">$2,200 </option>
                    <option value="$2,300 ">$2,300 </option>
                    <option value="$2,400 ">$2,400 </option>
                    <option value="$2,500 ">$2,500 </option>
                    <option value="$2,600 ">$2,600 </option>
                    <option value="$2,700 ">$2,700 </option>
                    <option value="$2,800 ">$2,800 </option>
                    <option value="$2,900 ">$2,900 </option>
                    <option value="$3,000 ">$3,000 </option>
                    <option value="$3,100 ">$3,100 </option>
                    <option value="$3,200 ">$3,200 </option>
                    <option value="$3,300 ">$3,300 </option>
                    <option value="$3,400 ">$3,400 </option>
                    <option value="$3,500 ">$3,500 </option>
                    <option value="$3,600 ">$3,600 </option>
                    <option value="$3,700 ">$3,700 </option>
                    <option value="$3,800 ">$3,800 </option>
                    <option value="$3,900 ">$3,900 </option>
                    <option value="$4,000 ">$4,000 </option>
                    <option value="$4,100 ">$4,100 </option>
                    <option value="$4,200 ">$4,200 </option>
                    <option value="$4,300 ">$4,300 </option>
                    <option value="$4,400 ">$4,400 </option>
                    <option value="$4,500 ">$4,500 </option>
                    <option value="$4,600 ">$4,600 </option>
                    <option value="$4,700 ">$4,700 </option>
                    <option value="$4,800 ">$4,800 </option>
                    <option value="$4,900 ">$4,900 </option>
                    <option value="$5,000+ ">$5,000+ </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Credit Rating :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <select name="CreditSelection">
                    <option value="Excellent">Excellent </option>
                    <option value="Good">Good </option>
                    <option value="Fair">Fair </option>
                    <option value="Poor">Poor </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td colspan="2"><div align="center"><font color="#0066CC" size="-1" face="Times New Roman, Times, serif">CO-BORROWER
                  INFORMATION (OPTIONAL)</font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">First
                  Name :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield86" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Last
                  Name :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield87" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">E-mail
                  : </font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield88" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Home
                  Telephone Number :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield89" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td height="24"><div align="right">
                  <p><font size="-1" face="Times New Roman, Times, serif">Work
                    Telephone Number : </font></p>
                </div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield810" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Employer
                  Name :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield811" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Occupation
                  : </font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield812" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Time
                  on Job :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <select name="select2" id="select">
                    <option value="Years ">Years </option>
                    <option value="1 Year ">1 Year </option>
                    <option value="2 Years ">2 Years </option>
                    <option value="3 Years ">3 Years </option>
                    <option value="4 Years ">4 Years </option>
                    <option value="5 Years ">5 Years </option>
                    <option value="6 Years ">6 Years </option>
                    <option value="7 Years ">7 Years </option>
                    <option value="8 Years ">8 Years </option>
                    <option value="9 Years ">9 Years </option>
                    <option value="10 Years ">10 Years </option>
                    <option value="11 Years ">11 Years </option>
                    <option value="12 Years ">12 Years </option>
                    <option value="13 Years ">13 Years </option>
                    <option value="14 Years ">14 Years </option>
                    <option value="15+ Years ">15+ Years </option>
                  </select>
                  <select name="select3">
                    <option value="Months ">Months </option>
                    <option value="1 Month ">1 Month </option>
                    <option value="2 Months ">2 Months </option>
                    <option value="3 Months ">3 Months </option>
                    <option value="4 Months ">4 Months </option>
                    <option value="5 Months ">5 Months </option>
                    <option value="6 Months ">6 Months </option>
                    <option value="7 Months ">7 Months </option>
                    <option value="8 Months ">8 Months </option>
                    <option value="9 Months ">9 Months </option>
                    <option value="10 Months ">10 Months </option>
                    <option value="11 Months ">11 Months </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Monthly
                  Gross Income :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <select name="select4">
                    <option value="Select ">Select </option>
                    <option value="Less than $500.00 ">Less than $500.00 </option>
                    <option value="$500 ">$500 </option>
                    <option value="$600 ">$600 </option>
                    <option value="$700 ">$700 </option>
                    <option value="$800 ">$800 </option>
                    <option value="$900 ">$900 </option>
                    <option value="$1000 ">$1000 </option>
                    <option value="$1,100 ">$1,100 </option>
                    <option value="$1,200 ">$1,200 </option>
                    <option value="$1,300 ">$1,300 </option>
                    <option value="$1,400 ">$1,400 </option>
                    <option value="$1,500 ">$1,500 </option>
                    <option value="$1,600 ">$1,600 </option>
                    <option value="$1,700 ">$1,700 </option>
                    <option value="$1,800 ">$1,800 </option>
                    <option value="$1,900 ">$1,900 </option>
                    <option value="$2,000 ">$2,000 </option>
                    <option value="$2,100 ">$2,100 </option>
                    <option value="$2,200 ">$2,200 </option>
                    <option value="$2,300 ">$2,300 </option>
                    <option value="$2,400 ">$2,400 </option>
                    <option value="$2,500 ">$2,500 </option>
                    <option value="$2,600 ">$2,600 </option>
                    <option value="$2,700 ">$2,700 </option>
                    <option value="$2,800 ">$2,800 </option>
                    <option value="$2,900 ">$2,900 </option>
                    <option value="$3,000 ">$3,000 </option>
                    <option value="$3,100 ">$3,100 </option>
                    <option value="$3,200 ">$3,200 </option>
                    <option value="$3,300 ">$3,300 </option>
                    <option value="$3,400 ">$3,400 </option>
                    <option value="$3,500 ">$3,500 </option>
                    <option value="$3,600 ">$3,600 </option>
                    <option value="$3,700 ">$3,700 </option>
                    <option value="$3,800 ">$3,800 </option>
                    <option value="$3,900 ">$3,900 </option>
                    <option value="$4,000 ">$4,000 </option>
                    <option value="$4,100 ">$4,100 </option>
                    <option value="$4,200 ">$4,200 </option>
                    <option value="$4,300 ">$4,300 </option>
                    <option value="$4,400 ">$4,400 </option>
                    <option value="$4,500 ">$4,500 </option>
                    <option value="$4,600 ">$4,600 </option>
                    <option value="$4,700 ">$4,700 </option>
                    <option value="$4,800 ">$4,800 </option>
                    <option value="$4,900 ">$4,900 </option>
                    <option value="$5,000+ ">$5,000+ </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td height="22"><div align="right"><font size="-1" face="Times New Roman, Times, serif">Credit
                  Rating :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <select name="select5">
                    <option value="Excellent">Excellent </option>
                    <option value="Good">Good </option>
                    <option value="Fair">Fair </option>
                    <option value="Poor">Poor </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td height="27" colspan="2"><div align="center"><font color="#0033CC" size="-1" face="Times New Roman, Times, serif">PROPERTY
                  INFORMATION</font> </div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Property Type :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <select name="PropertyType">
                    <option value="Select ">Select </option>
                    <option value="Single Family ">Single Family </option>
                    <option value="Condominium ">Condominium </option>
                    <option value="Duplex ">Duplex </option>
                    <option value="Triplex ">Triplex </option>
                    <option value="4 Unit ">4 Unit </option>
                    <option value="5-10 Units ">5-10 Units </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*
                  </font><font size="-1" face="Times New Roman, Times, serif">Time
                  in House :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <select name="select6" id="select2">
                    <option value="Years ">Years </option>
                    <option value="1 Year ">1 Year </option>
                    <option value="2 Years ">2 Years </option>
                    <option value="3 Years ">3 Years </option>
                    <option value="4 Years ">4 Years </option>
                    <option value="5 Years ">5 Years </option>
                    <option value="6 Years ">6 Years </option>
                    <option value="7 Years ">7 Years </option>
                    <option value="8 Years ">8 Years </option>
                    <option value="9 Years ">9 Years </option>
                    <option value="10 Years ">10 Years </option>
                    <option value="11 Years ">11 Years </option>
                    <option value="12 Years ">12 Years </option>
                    <option value="13 Years ">13 Years </option>
                    <option value="14 Years ">14 Years </option>
                    <option value="15+ Years ">15+ Years </option>
                  </select>
                  <select name="select7">
                    <option value="Months ">Months </option>
                    <option value="1 Month ">1 Month </option>
                    <option value="2 Months ">2 Months </option>
                    <option value="3 Months ">3 Months </option>
                    <option value="4 Months ">4 Months </option>
                    <option value="5 Months ">5 Months </option>
                    <option value="6 Months ">6 Months </option>
                    <option value="7 Months ">7 Months </option>
                    <option value="8 Months ">8 Months </option>
                    <option value="9 Months ">9 Months </option>
                    <option value="10 Months ">10 Months </option>
                    <option value="11 Months ">11 Months </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Loan Type :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <select name="LoanType">
                    <option value="Select ">Select </option>
                    <option value="Home Purchase ">Home Purchase </option>
                    <option value="Refinancing ">Refinancing </option>
                    <option value="Cash Out ">Cash Out </option>
                    <option value="Conforming ">Conforming </option>
                    <option value="FHA ">FHA </option>
                    <option value="VA ">VA </option>
                    <option value="Jumbo ">Jumbo </option>
                    <option value="Fixed ">Fixed </option>
                    <option value="Adjustable ">Adjustable </option>
                  </select>
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Mortgage Company :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield813" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Interest Rate :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield814" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Mortgage Payment :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield815" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Mortgage Balance :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield816" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font size="-1" face="Times New Roman, Times, serif">Second
                  Mortgage Balance (Option) :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield817" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*</font><font size="-1" face="Times New Roman, Times, serif">
                  Purchase Price :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield818" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1">*</font><font size="-1">
                  Property Value :</font></div></td>
              <td><div align="left"> <font size="-1">
                  <input name="textfield819" type="text" size="40">
                  </font></div></td>
            </tr>
            <tr>
              <td><div align="right"><font color="#FF0000" size="-1" face="Times New Roman, Times, serif">*
                  </font><font size="-1" face="Times New Roman, Times, serif">How
                  did you hear about us? :</font></div></td>
              <td><div align="left"><font size="-1" face="Times New Roman, Times, serif">
                  <input name="textfield820" type="text" size="40">
                  </font></div></td>
            </tr>
          </table>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p>&nbsp;</p>
          <p align="center">&nbsp;</p>
          <p align="center">&nbsp;</p>
          <p align="center"><font size="-1">
            <input type="submit" name="Submit" value="Submit">
            &nbsp;
            <input type="reset" name="Submit2" value="Cancel">
            </font></p>
          <p align="center"><font size="-1"> </font></p>
        </form>
        <font size="-1"><br>
        </font> </div></td>
    <td width="98">&nbsp;</td>
  </tr>
  <tr>
    <td height="168"></td>
    <td width="111"></td>
    <td width="440">&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td height="30" colspan="4" valign="top"><div align="center"><font size="-1">Copyright
        ¨Ï 2005 Fast Line Mortgage, Inc. All rights reserved. Design by INMO Design
        Inc.</font></div></td>
  </tr>
</table>
<form name="form1" method="post" action="">
</form>
</body>
</html>

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HappyCGI 2005-01-31 20:38:56
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