LOAN OFFICER / LENDER Company (required) Contact (required) Email (required) Phone (required) Fax Direct Address City State, ZIP REFINANCE PROPERTY INFORMATION Address (required) City (required) State, ZIP County Parcel Number Legal Description OWNER 1 Name Home Phone Cell Phone Email Address (if different than above) City, State, ZIP (if different than above) OWNER 2 Name Home Phone Cell Phone Email Address (if different than above) City, State, ZIP (if different than above) LOAN INFORMATION Transaction Type —Please choose an option—ConventionalFHAVA Anticipated Closing Date Lender's Policy Amount New Loan Number Loan Officer Loan Officer Phone Loan Officer Email SURVEY Survey required? YesNo Surveyor Name CURRENT MORTGAGE INFORMATION Mortgage Company #1 Company 1 Account Number Phone Fax Mortgage Company #2 Company 2 Account Number Phone Fax ADDITIONAL COMMENTS CONTACT INFO Email team@expresstc.com johnson city 2909 E. Oakland Ave Suite 103C, Johnson City, TN 37601 phone +1 423-434-9200 Business Hours Monday – Friday :: 8am – 5pm Fax +1 866-777-6521