DISCOUNT HOME LOANS

APPLICATION

 
Please fill out the form below and submit it to us. 
All information is kept confidential.

 

CONTACT INFORMATION

Name:               

Street Address:   

City:                      

State:                   

Zip Code:                    

Home Telephone Number:   

Office Telephone Number:   

Fax Number:                          

Email Address:               

What is the best time and place to contact you:

INFORMATION REGARDING YOUR CURRENT RESIDENCE

How long have you lived in your current residence:

What is your current monthly payment:        $

What is the estimated value of your home: $

How much do you owe on your home:         $

What is the current interest rate on your home: 

What type of loan do you have now:     

What is your total household income: $

EMPLOYMENT INFORMATION

Are you Self-Employed:

How long have you been employed in the same industry:

Husband:                        Wife:

PERSONAL INFORMATION

What is your social security number(s):

Husband:                       Wife:

 

What is the purpose of your loan:

 

Please enter any additional information or comments: