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About Your Loan Program Loan Program Loan Purpose 30 Year Fixed 15 Year Fixed 5 Yr Balloon 7 Yr Balloon 1/1 ARM 3/1 ARM 5/1 ARM VA 30 Yr FHA 30 Yr FHA ARM PurchaseRefinanceConstr. LoanSee Comments/OtherFHA LoanVA Loan Loan Amount ($) Property Value ($) Estimated Timeframe < 30 Days 30-60 Days 60-90 Days Not Sure 120 Property Information Property Type - Single family Condo Commercial Investment Co-op Mobile Home Multi Family Address Zip Borrower Information First Name Last Name Work Phone Home Phone Email Employment Information Self Employed Years Employed Annual Income($) no yes 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 < $20,000 $20,000-25,000 $25,000-30,000 $30,000-35,000 $35,000-40,000 $40,000-45,000 $45,000-50,000 $50,000-60,000 $60,000-70,000 $70,000-80,000 $80,000-90,000 $90,000-100,000 $100,000-125,000 $125,000-150,000 $150,000-175,000 $175,000-200,000 > 200,000 Income and Expense Information Monthly Expenses($) Credit History Excellent Good Fair Poor Once you have completed this expression of interest or application your information will be sent to First City Bancorp. A representative from First City Bancorp may contact you by telephone or email. By submitting your expression of interest you are consenting to receive telephone calls or email from First City Bancorp.

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