Heather Parnass, ABR
(954) 812-6741
HPRealty@live.com

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onSubmit="MM_validateForm('FirstName','','R','LastName','','R','Email','','RisEmail','BorrowAmount','','NisNum','MonthlyIncome','','NisNum','MonthlyHousingCost','','NisNum','OtherMonthlyExpenses','','NisNum','ZipCode','','NisNum','Phone','','R');return document.MM_returnValue"><input type="hidden" name="MLS" value=""><input type="hidden" name="PropAddress" value=""><table width="725" cellpadding="1" cellspacing="2"><tr><td colspan="4" class="celltext"><table width="100%" style="height:100%;" border="0" align="right" cellpadding="3" cellspacing="0"><tr><td width="50%" valign="top" align="center" class="textHF"></td></tr></table></td></tr><tr><td colspan="4" class="celltext" align="right" height="25" valign="middle"><a onClick="self.status='';return true;" onMouseOver="self.status='Return to the previous page';return true;" onMouseOut="self.status='';return true;" href="javascript:window.history.back()">< Back</a></td></tr><tr><td colspan="4" height="25" class="title">Get Pre-Qualified</td></tr><tr><td colspan="2" class="celltextBOLD">Personal Information:</td><td colspan="2" class="celltextBOLD">Optional Information: </td></tr><tr><td width="20%" class="celltextcolor" align="right">*First Name:</td><td width="25%" class="celltext"><input name="FirstName" type="text" class="srhBox" size="20"></td><td width="20%" class="celltextcolor" align="right">Address:</td><td width="25%" class="celltext"><input name="Address" class="srhBox" size="20" maxlength="100"> </td></tr><tr><td width="20%" class="celltextcolor" align="right">*Last Name:</td><td width="25%" class="celltext"><input name="LastName" type="text" class="srhBox" size="20"></td><td width="20%" class="celltextcolor" align="right">City:</td><td width="25%" class="celltext"><input name="City" class="srhBox" size="20" maxlength="100"> </td></tr><tr><td width="20%" class="celltextcolor" align="right">*Email Address:</td><td class="celltext" class="text"><input name="Email" type="text" class="srhBox" size="20"></td><td width="20%" class="celltextcolor" align="right">State/Province:</td><td class="celltext"> <select name="State" id="state"><option value="" selected>Select One</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="DE">Delaware</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="HI">Hawaii</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="IA">Iowa</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="ME">Maine</option><option value="MD">Maryland</option><option value="MA">Massachusetts</option><option value="MI">Michigan</option><option value="MN">Minnesota</option><option value="MS">Mississippi</option><option value="MO">Iowa</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">Viriginia</option><option value="WA">Washington</option><option value="DC">Washington DC</option><option value="WV">West Virignia</option><option value="WI">Wisconsin</option><option value="WY">Wyoming</option></select> </td></tr><tr><td width="20%" class="celltextcolor" align="right">*Phone Number :</td><td class="celltext"> <input name="Phone" class="srhBox" size="20" maxlength="15"></td><td width="20%" class="celltextcolor" align="right">ZIP/Postal Code :</td><td class="celltext"> <input name="ZipCode" class="srhBox" size="10" maxlength="10"></td></tr><tr><td colspan="1" class="celltextcolor" valign="top" align="right">Comments:</td><td width="" valign="top" class="celltext" colspan="3"><textarea name="Comments" cols="72" rows="4" wrap="physical" class="srhBox"></textarea></td></tr><tr><td height="" colspan="4" class="celltext"> </td></tr><tr><td colspan="2" class="celltextcolor">How much would you like to borrow? </td><td colspan="2" class="celltext">$<input name="BorrowAmount" type="text" class="srhBox" value="" size="10"></td></tr><tr><td colspan="2" class="celltextcolor">Do you have a co-borrower?</td><td colspan="2" class="celltext"><select name="CoBorrower"><option value="" selected>Select One</option><option value="yes">Yes</option><option value="no">No</option></select></td></tr><tr><td colspan="2" class="celltextcolor">Do you prefer a fixed or adjustable rate? </td><td colspan="2" class="celltext"><select name="RateType"><option value="" selected>Select One</option><option value="adjustable">Adjustable</option><option value="fixed rate">Fixed Rate</option></select></td></tr><tr><td colspan="2" class="celltextcolor">Desired term of loan:</td><td colspan="2" class="celltext"><select name="LoanTerm"><option value="" selected>Select One</option><option value="15-year">15-year</option><option value="30-year">30-year</option><option value="Other">Other</option><option value="No preference">no prefs</option></select></td></tr><tr><td colspan="2" class="celltextcolor">Your employment status:</td><td colspan="2" class="celltext"><select name="EmploymentStatus"><option value="" selected>Select One</option><option value="employed">employed</option><option value="self-employed">self-empployed</option><option value="retired">retired</option><option value="other">other</option></select></td></tr><tr><td colspan="2" class="celltextcolor">How long have you had your current position?</td><td colspan="2" class="celltext"><input name="LengthOfCurrentPosition" class="srhBox" size="5" maxlength="5">years</td></tr><tr><td colspan="2" class="celltextcolor">Co-borrower's employment status: </td><td colspan="2" class="celltext"><select name="CoBorrowersEmploymentStatus"><option value="" selected>Select One</option><option value="employed">employed</option><option value="self-employed">self-empployed</option><option value="retired">retired</option><option value="other">other</option></select></td></tr><tr><td colspan="2" class="celltextcolor">How long has the co-borrower had this position?</td><td colspan="2" class="celltext"><input name="LengthOfCoBorrowersCurrentPosition" class="srhBox" size="5" maxlength="5">years</td></tr><tr><td colspan="2" class="celltextcolor">Do you currently own or rent your home?</td><td colspan="2" class="celltext"><select name="OwnOrRent"><option value="" selected>Select One</option><option value="own">own</option><option value="rent">rent</option></select></td></tr><tr><td colspan="2" class="celltextcolor">Your monthly income:</td><td colspan="2" class="celltext">$<input name="MonthlyIncome" class="srhBox" size="10" maxlength="15"> </td></tr><tr><td colspan="2" class="celltextcolor">Your monthly housing cost:</td><td colspan="2" class="celltext">$<input name="MonthlyHousingCost" class="srhBox" size="10" maxlength="15"></td></tr><tr><td colspan="2" class="celltextcolor">Other monthly expenses and debts:</td><td colspan="2" class="celltext">$<input name="OtherMonthlyExpenses" class="srhBox" size="10" maxlength="15"></td></tr><tr><td colspan="4" class="celltext">* By submitting this form with your telephone number you are consenting for Heather Parnass and all authorized representatives to contact you even if your name is on the <a href="https://www.donotcall.gov/default.aspx" target="_new">Federal Do-Not-Call List</a><br><br><a href="#" onClick="window.open('custPrivacyPolicy.asp?id=PAR001','Terms','scrollbars=yes,width=450,height=250')">Privacy Policy</a></td></tr><tr class="celltextcolor"><td colspan="4" class="celltext"><table width="60%" border="0" align="center" cellpadding="3" cellspacing="0"><tr><td width="50%"><div style="text-align: center"><img id="imgCaptcha" src="captcha.asp" alt="Security Code"><br><a href="javascript:void(0)" onclick="RefreshImage('imgCaptcha')">Change Image</a></div></td><td width="50%"><div class="celltext" style="width: 140px">Confirm Security Code:</div><div class="field-right"><input name="SecurityCode" class="srhBox" type="text" id="SecurityCode" size="10" /></div></td></tr></table></td></tr><tr><td colspan="4" class="celltextcolor"><table width="15%" border="0" align="center" cellpadding="3" cellspacing="0"><tr><td width="21%"><input onClick="self.status='';return true;" onMouseOver="self.status='Click to begin search';return true;" onMouseOut="self.status='';return true;" type="image" src="images/send.gif" name="Submit"></td><td width="79%"><a onClick="self.status='';return true;" onMouseOver="self.status='Click to reset form';return true;" onMouseOut="self.status='';return true;" href="javascript:form1.reset()"><img src="images/reset.gif" border="0"></a></td></tr></table></td></tr><tr><td colspan="4" class="celltext" valign="top"><table width="100%" border="0" align="center" cellpadding="3" cellspacing="0"><tr><td colspan="4" class="text" align="right" valign="top"><a onClick="self.status='';return true;" onMouseOver="self.status='Return to the previous page';return true;" onMouseOut="self.status='';return true;" href="javascript:window.history.back();">< Back</a></td></tr></table></td></tr><tr><td colspan="4" valign="top" class="celltext"><table width="100%" height="100%" border="0" cellpadding="3" cellspacing="0"><tr><td valign="top" align="center" class="textHF"></td></tr></table></td></tr><tr><td height="1" colspan="2" valign="top" class="celltext" align="center"><a href="http://www.resionline.com" target="_blank"><img src="../megatemplate/images/resilogo.png" width="96" height="39" border="0" alt="Real Estate Web Design"></a></td></tr></table></form>
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