Mortgage Request Form
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Name
Name
Borrower
Information
Borrower 1
Borrower 2
Current Address
Addr (if different)
City
City
State
State
Zip
Zip
Hm Phone
Hm Phone
Wk Phone
Wk Phone
E-Mail
E-Mail
Marital Status
Marital Status
Credit
Information
Borrower 1
Borrower 2
Date of Birth
Date of Birth
Social Security #
Social Security #
Credit Rating
Credit Rating
Bankruptcy?
Bankruptcy?
Foreclosure?
Foreclosure?
Employer
Employer
Position
Position
Years there
Years there
Monthly Income
Monthly Income
Monthly Cr Cd Debt
Monthly Cr Cd Debt
Loan
Information
Type of loan
If Refinance
Amount of loan
Current Mortgage
Type of property
Property location (if other than above)
Residence type
Please Select
Married
Divorced
Separated
Single
Please Select
Married
Divorced
Separated
Single
Please Select
Excellent
Good
Average
Below Average
Please Select
Excellent
Good
Average
Below Average
Please Select
No-Never
Yes-Within 7 yrs
Yes- Over 7 yrs
Please Select
No-Never
Yes-Within 7 yrs
Yes- Over 7 yrs
Please Select
No-Never
Yes-Within 7 yrs
Yes- Over 7 yrs
Please Select
No-Never
Yes-Within 7 yrs
Yes- Over 7 yrs
Please Select
Lower Payments
Debt Consolidation
Home Improvement
Cash
Other
Please Select
Purchase
Refinance
Please Select
Single Family detached
Single Family Townhome
Single Family Condo
Multi-Family Building
Manufactured Home
Other
Please Select
Primary Residence
Secondary Residence
Investment Property