MORTGAGE QUICK APPLICATION

A loan officer may contact you. A phone number is required.

The information you enter on this form will be kept in strict confidence.

PLEASE DO NOT USE DOLLAR SIGNS ($) OR COMMAS ( , ) WHEN ENTERING NUMBERS.

	Mortgage Type:	1st 2nd Home Equity
	Amount Requested:	$

Property To Be Financed (if known)
Address:		Apt. or Unit# :
City:	State:		Zip:

IF REFINANCING FILL OUT THE FOLLOWING INFORMATION and then continue with Form

When did you purchase?	yr. mo.
How much did you pay?	$
What do you think it is worth today?	$
Do you own other properties?	Yes No	If so how many?
Are you occupying your present home?	Yes No

Existing Mortgages		1st Mortgage	2nd Mortgage
Please enter below the monthly information for:	Mgt. Balance	$	$
Taxes & Insurance Monthly Mortgage (Are taxes and insurance included in your payment? Yes)		$	$

IF PURCHASE FILL OUT THE FOLLOWING INFORMATION

When do you expect to purchase?	yr. mo.
When will home be completed?	yr. mo.
What is the purchase price, or how much would you like to finance?	$
What is your down payment?	$
Do you own other properties?	Yes No	If so how many?
What is the source of your down payment?	SavingsSell of existing homeGift
Are you selling or leasing your present home?	SellingLeasing

Personal Information
	Applicant	Co-Applicant
First Name
Last Name
Social Security Number
E-Mail (e.g. jim@jupiterwellington.com)
Home Phone
Fax
How would you rate your credit?
Are you married to the Co-Applicant?
Best time to contact you?

If purchase address is different than the property address
Did you?	How long?		yrs. mo
Address:		Apt. or Unit# :
City:		State:	Zip:

Current Address (if less than 2 yrs. at current) or If Purchase Actual Address.
Did you?	How long?		yrs. mo
Address:		Apt. or Unit# :
City:		State:	Zip:

Employment History

Applicant

Co-Applicant

Employer Name

Gross Monthly Income*

Your Position (title)

Self-Employed

Yes No

Length with Company

yrs. mos.

Phone Number

Previous Employer (if less than 2 yrs. at current)

Employer Name

Gross Monthly Income

Your Position

Length with Company

yrs. mos.

Phone Number

Comments

* Before taxes & deductions

By submitting this on-line application, I/We authorize First American Mortgage to check such information as my/our credit, business and employment status and history. Submitting this application does not lock-in rate. Please call Jim Reid at 561-602-2696 if you have any questions.

of South Florida, Inc.