testttt FIRST NAME* LAST NAME* EMAIL* HOME PHONE* LOAN AMOUNT* Select$100,000 - $150,000$150,000 - $200,000$200,000 - $250,000$250,000 - $300,000 PROPERTY VALUE* Select$100,000 - $150,000$150,000 - $200,000$200,000 - $250,000$250,000 - $300,000 LOAN TYPE* SelectPurchase LoanRefinance LoanDebt ConsolidationHome Equity CREDIT HISTORY* SelectExcellentGoodFairPoor