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<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"> </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 </font><font size="-1" face="Times New Roman, Times, serif"> <font color="#FF0000"> *
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> </p>
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<p> </p>
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<p> </p>
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<p> </p>
<p> </p>
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<p> </p>
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<p> </p>
<p> </p>
<p> </p>
<p align="center"> </p>
<p align="center"> </p>
<p align="center"><font size="-1">
<input type="submit" name="Submit" value="Submit">
<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"> </td>
</tr>
<tr>
<td height="168"></td>
<td width="111"></td>
<td width="440"> </td>
<td> </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>