Mortgage Application Form

Complete this form if you are interested in receiving information about a mortgage loan.
Instructions:
  1. Complete the general information section.
  2. Complete the section that applies to your needs:
    • The purchase section only if buying a home.
    • The refinance section only if refinancing.
    • The credit line/equity loan section if applying for 2nd mortgage.
  3. Click on the send button.
I will be in touch with you shortly to discuss your financing options. Thank you!

General Section

Contact Information
Name
Home Phone
Work Phone
E-mail
Best time to reach me
Property Location
City State
Loan Request

Purchase
Refinance
Credit Line
Home Improvement
Other, please describe: 

Loan Amount

Loan amount desired is $

Type of Loan

30 yr fixed
15 yr fixed
30/5 yr fixed
\ 30/7 yr fixed
Adjustable
Haven't decided
Other, please state 

Personal Information

Annual household income is $
My credit history is
Excellent
Good, but some lates
Some credit problems
Major credit problems
Don't know 

Purchase Section

FILL THIS OUT IF PURCHASING A HOME

Please skip to the next section if refinancing

Time Frame

Thinking about it
Actively Looking
About to make an offer
Have a sales contract

Real Estate Professional Information

I am working with a Real Estate Professional
Please refer me to a Real Estate Professional
I am buying directly from the seller
I am buying directly from the builder

Purchase Price

I expect to buy a home between $ and $

Down Payment

I expect to put between  % and  % down 

Refinance Section

FILL THIS OUT ONLY IF REFINANCING

Please skip to the next section if applying for a second mortgage

Property Value

The property should appraise for $
Don't know

Existing loans on property
1st loan balance $
2nd loan balance $
3rd loan balance $
Reason for Refinancing

Reduce Interest rates
Change from fixed to adjustable
Change from adjustable to fixed
Need cash out. Cash out required $
Other, please specify... 

Current loan type

Fixed
Adjustable
Other, please specify... 

Second Mortgage Section

FILL THIS OUT IF REQUESTING A SECOND MORTGAGE, CREDIT LINE, OR HOME IMPROVEMENT LOAN

Type of loan

Credit line
Fixed 2nd mortgage
Other, please state... 

Existing loans on property

1st loan $
2nd loan $
Do any of the loans have negative amortization?
Yes
No
Don't know

Reason for loan

Home improvement
Pay off bills
Other, please specify...