MEMBER SERVICES/ PROCESSING CENTER 146 N.W.84TH WAY, SUITE A-100, CORAL SPRINGS, FL 33071 Tel. (954)255-3018 - Fax (954) 345-5791 E-Mail: MortgageTrust@Aol.Com |  |
Date: ___/___/___ Office #: ________ Loan Officer:_______________ Notes:__________________________________________________________________ Applicant Name:___________________________ Dr.Lic.#____________________ Social Security #:________________________ Date Of Birth:____/____/____ Address:__________________________________ ________________________ Own or Rent:________ Name of Owner(s):_______________________________ Contact Info: Home tel. #________________ Fax tel. #___________________ Cel. Tel. #_______________ Bp. #____________ E-mail:____________ Employer:__________________ Position:_________ How Long:_______________ Address:________________________________________________________________ Annual Income:$________________ Savings+Investments:$___________________ Previous Employer(if less than 2 years):________________________________ Interested in New or Discounted Mortgage? Yes or No How Soon? _____Purpose of Mortgage? Buy New House or Refinance Present House? Describe Desired New Home (location, price, size, etc.): _______________ Refinancing Existing Property (describe):_______________________________ Home Purchase Date:______ Purchase Price:$_______ Selling Date:_______ Current Value:$_______ Mortgage Balance:$_______ Mo. Payment:$_________ Interest Rate:%_____ Mtg. Holder:__________ Acct. #:________________ House Type: Single Family or Other_______ Year Built:____ Residents:____ Square Footage(without garage):_______ Bedrooms/Baths:_________
I authorize and grant you or any assignee limited power of attorney to make whatever credit and/or employment inquiries that may be deemed necessary in connection with this application for credit repair, loan or mortgage approval. I agree to hold you and your employees, officers and agents harmless for any claims, suits, actions or demands arising out of this application and will not hold you responsible for any credit rating past, present, or future.
Signature of Applicant __________________________ _____________ Print Full Name _______________________________ Date