Mortgage Application Form

Agent Name:

Agent Email:

Agent Phone #:

Client # 1 Name:

Client #1 DOB:

Email:

Phone number:

Client # 2 Name:

Client #2 DOB:

Email:

Phone number:

Address:

City:

State:

Zip:

PROPERTY INFORMATION/VALUES

Fair Market Value of Property: $

Current Balance: $

Current Interest rate (APR):

Yrs remaining on current mortgage:

Mortgage Pymt. (w/taxes & ins.): $

This Property is Classified as?

a Primary Residence

a Secondary Residence

Investment Property

INCOME & EXPENSES

Net Household Monthly Income: $

**Est. Monthly Expenses: $

Liquid Savings: $

What is Your Current Credit Score?

**Please include ALL EXPENSES (MORTGAGE, Cars, Credit Cards, Utilities, Groceries, Dining Out, Gas, Child Care, Student Loans, ETC.)

***You do not need to be exact, BUT please be as accurate in your estimating as possible

ADDITIONAL DEBTS/LOANS

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NOTES/Additional loans:

Application Submitted!