Loan Information Form

Instructions

  1. Use this form to request mortgage information.
  2. Please fill out as much of this form as possible.
  3. When finished click on the send button.
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How did you find this Web site?

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

General Information

Borrower Co-borrower
(If different)
Full Name:
Address:
City, State, Zip
Home Phone:
Work Phone:
Best time to contact:
E-mail:
Social Security #:
Employers:
Employers' Phone Number:
Are you self employed ? YesNo 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		 excellent
good, but some lates
some credit problems
major credit problems
don't know

Loan Request

Amount Requested:
Type of loan:

Property Information

(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/VacationInvestment
Purchase Amount:

Loan Information

Mortgage Balances Amount: Held by: Payment:
First:
Second:
Other:
Creditors Amount Owed Monthly Payment Will you pay this off ?
$ $ Yes No
$ $ Yes No
$ $ Yes No
$ $ Yes No

Other monthly debts and information - please describe

By submitting this on-line application, I/We authorize United American Mortgage to check such things as my/our credit, business and employment status and histories.

email - dhensling@uamco.com