Contact information
Applicant's Name:
Age:
Co-applicant's Name (if any):
Age:
Street Address:
City: State: Zipcode:
Social Security #
email address to reach you:
(Be sure to include your area code, and your work phone extension if
applicable.)
Home Phone: Work Phone:
Please check the best time(s) to call you. Daytime: Evening:
Saturday:
Loan request information
Purpose of the mortgage?
New Purchase: Refinance
1st TD: Refinance
2nd TD: Refinance
all:
Which loan programs interest you?
Fixed: Adjustable
Rate (ARM): Graduated
Payment: No
Fee Loan:
Property type:
Estimated current market value or purchase price of the property:
Loan amount requested:
For refinance loans or bill consolidation, please complete the following:
Total amount of bills you want to pay off (finance loans, credit cards,
car loans, etc.):
Existing loan balances on the property to be refinanced:
Total loan balance (A. +
B. + C.)
A. 1st Trust deed balance
B. 2nd Trust deed balance
C. Total balance of other
loans on the property
Please describe other loans on property (C.), e.g., leins.
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