Instructions

1. Please fill out as much of this form as possible.

2. When finished insert the E-mail address of your Certified Loan Broker and click on the Submit button.

A Certified Loan Broker will contact your within 24 hours for any additional information needed.

How did you find this Web Site?

Please enter the Web Address of the document that led you to this site:

General Information:

Borrower      

Full Name:

Address:

City: State: Zip:

Home Phone:               Cellular Phone:

Work Phone:                Fax:

Best time to contact:

E-mail:

Social Security #:

Employer's Name:

Employer's Phone #:

Are you self employed? Yes No

Length of Employment:

Gross Monthly Income:

Date of Birth?

 

My credit history is

Excellent

Good, but some lates 

Some credit problems

Major credit problems

Don't know

 

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Co-Borrower

Full Name:   Relationship:

Address:

City: State: Zip:

Home Phone:        Cellular Phone:

Work Phone:        Fax:

Best time to contact:

E-mail:

Social Security #:

Employers' Name:

Employers' Phone #:

Are you self employed? Yes No

Length of Employment:

Gross Monthly Income:

Date of Birth?

 

Co-Borrowers credit history is    

 

Excellent                        

Good, but some lates  

Some credit problems 

Major credit problems  

Don't know                 

Loan Request

Amount Requested:

Type of loan:          --Select-- Purchase Refinance

 

Property Information (For Refinance only)

(This information needs to be filled out for property that is collateral for the loan)

Street Address:

City: State: Zip Code:

Estimated Present Value:

Year Purchased:

Original Price:

Type of Property: Primary Second/Vacation Investment

Purchase Amount:

Property Information (For Purchase Only)

Time Frame: Thinking about it Actively looking About to make an offer Have a sales contract

Realtors Information:

Purchase Price:

Down Payment Amount:

Street Address:

City: State: Zip Code:

Type of Property: Primary Second/Vacation Investment

Loan Information

Mortgage Balances 

                         Amount:                             Lender:                               Payment:

First:                  

Second:      

Other:                

           

 

^{Will you pay this 
off with this loan?
Creditors      ~   Amount Owed   ~      Monthly Payment}                                 

                             

 $  $     Yes No

 $  $     Yes No

 $  $     Yes No

 $  $     Yes No

Other monthly debts and information - please describe

By submitting this on-line application, I/We authorize you to obtain information regarding my/our credit, business and employment status and histories.