PROFILE SUMMARY
PRIMARY BORROWER:
1. Last Name	2. First Name	3. MI
4. Mailing Address
5. City	6. State	7. ZIP Code

8. Home Phone	9. Fax	10. E-mail
11. Bus. Phone	12. Cell Phone	13. Best Time To Call (Day & Time)?

14. SSN (###-##-####)

15. Currently Employed?  NoYes > Self-EmployedYes > Other Company

CO-BORROWER (IF NONE, LEAVE BLANK AND SKIP TO NUMBER 31):
16. Last Name	17. First Name	18. MI
19. Mailing Address
20. City	21. State	22. ZIP Code

23. Home Phone	24. Fax	25. E-mail
26. Bus. Phone	27. Cell Phone	28. Best Time To Call (Day & Time)?

29. SSN (###-##-####)

30. Currently Employed?  NoYes > Self-EmployedYes > Other Company

CURRENT STATUS INFORMATION:

31. Do You Own A Home?  YesNo    If No, skip to number 34.

32. What Is Your Home Worth?   $

33. Please Provide A Breakdown, By Amount, Of All Present Mortgages. (First, Second,           Equity Line Of Credit, Private, Etc.)

POTENTIAL HOME INFORMATION:

34. Are You Currently Looking For A Mortgage To Purchase A Property? YesNo    If No,      skip to number 42.

35. Have You Found A Potential Home?  YesNo

36. Address

37. City      38. State:      39. ZIP Code

40. Property Type  ResidentialCommercialMixed Use         41. Asking Price  $      OR      Accepted Offer:  $

42. Are You Looking To Be Pre-Approved At This Time For A Purchase In The Near Future?      YesNo

43. Are You Currently In Foreclosure?  NoYes

44. Have You Ever Been Forceclosed Upon?  NoYes    If No, skip to number 46.

45. When Did Foreclosure Take Place? (MM/DD/YYYY)

46. Are There Any Current Judgements Against You?  NoYes    If No, skip to number 48.

47. Give Details (Type & Amount)

48. Have You Ever Declared Bankruptcy?  NoYes > Chapter 7Yes > Chapter 13  If No, skip to number 51.

49. When Filed? (MM/DD/YYYY)

50. If Discharged Or Dismissed When? (MM/DD/YYYY)

ADDITIONAL INFORMATION:

51. What Do You Wish To Accomplish With This Loan If Approved By A Lender? Please share your personal comments that you feel will help us understand your needs and find you the best referral. For instance, what's your time frame for wanting this loan? Is there a greater amount that you would like to be considered for? What is the least amount that you will accept if necessary? What hardships have you or are you suffering from due to your credit standing, lack of funds or previous loan denials? The more we know, the more we can help.

52. Credit Card Information Name Exactly As It Appears On Card: Card Number (1111-2222-3333-4444): Expiration Date (MM/YY): Your card will be charged a fee of $20 to obtain a credit report and for our referral services. The charge will appear as "Mortgage Solutions" on your statement. Your information is secure and safe to submit electronically, but if you do not wish to do so, please read below.

DISCLAIMER: By submitting this PROFILE SUMMARY electronically, via facsimile, postal mail or other means, you are confirming and verifying your request for DFSI Mortgage Solutions ("DFSIMS") to obtain a standard factual data credit report through a bona-fide reporting agency. Any reproduction of this PROFILE SUMMARY and Disclaimer made by reliable means (for example, photocopy or facsimile) will be deemed an original for purposes of categorizing a loan request and obtaining a referral to one of "DFSIMS" sources. You authorize "DFSIMS" to charge your credit card and agree to pay "DFSIMS" fee according to your cardholder agreement for your credit report and referral service. Please be advised that this is a non-refundable fee due to the nature of services rendered. PLEASE NOTE: "DFSIMS" is a loan locator/referral company and "DFSIMS" expects applicant to increase the possibilities of securing a loan once "DFSIMS" referral sources are utilized by the loan applicant. However, "DFSIMS" makes no warranty, expressed or implied, as to the level of success of the applicant's in securing said loan's from said referral sources. In the event applicant does not achieve the desired success after utilization of "DFSIMS" locator/referral services, applicant shall have no recourse against "DFSIMS" on any legal theory, whether based on representation, warranty or otherwise. Applicant assumes the entire risk as to the results of said loan-securing attempts by the utilization of "DFSIMS" services as specified herein. Irrespective of possible registration on the National "Do Not Call" Registry, by submitting your profile summary you are giving "DFSIMS" and/or "DFSIMS" lender contacts permission to call for purposes described herein. “DFSIMS” does not share any personal data submitted with any other organization(s) for purposes of solicitation(s) or for any other reason except to locate loans and lenders as described herein. Lenders may, at their sole discretion, discontinue or modify availability of any loan program without prior notice.

By clicking "Submit Profile Summary" you are confirming that you acknowledge, agree, and provide authorization according to the above disclaimer.

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DON'T WANT TO SUBMIT YOUR INFORMATION ELECTRONICALLY? NO PROBLEM! SUBMIT YOUR PROFILE SUMMARY VIA FAX OR US MAIL! Fill in the profile summary including credit card information then print the form by clicking "Print" on your browser's toolbar. No credit card? No problem! Include a personal check, bank or postal money order payable to DFSI Mortgage Solutions. The above terms, conditions and disclaimer apply to all submission methods. Fax or mail your profile summary to us here: Fax: 845.208.3459 DFSI Mortgage Solutions ATTN: Review & Placement 3663 Lee Road, Suite #162 Jefferson Valley, NY 10535