EmailMe Form - Quick Loan Application

Referred By:

Loan Amount Requested:

$ Dollars . Cents

Current/Estimated Value:

$ Dollars . Cents

Lien Position

First Lien

Second Lien

Purpose of Loan

Purchase

Re-Finance / Cash Out

Construction

Property will be:

Primary Residence

Second/Vacation Home

Investment Property

If Re-financed, is there a prepayment penalty?

Yes

No

If (Yes), What amount?

$ Dollars . Cents

Current Mortgage Balance?

$ Dollars . Cents

Original Purchase Price?

$ Dollars . Cents

Month and Year of Purchase?

Current Interest rate
if known:

Reason for Refinance & Cash out:

Borrower Information
Full Name

Prefix First Last Suffix

Social Security #:

Date of Birth:

MM / DD / YYYY

Marital Status:

Single

Married

Divorced

Widowed

Cell Phone Number:

### - ### - ####

Home Phone:

### - ### - ####

Email

Current Address:

Previous Address:
(if less than 2 years at current address)

Co-Borrower Information
Full Name:

Prefix First Last Suffix

Social Security #:

Date of Birth:

MM / DD / YYYY

Marital Status:

Single

Married

Divorced

Widowed

Cell Phone Number:

### - ### - ####

Borrower Employment Information
Company Name & Address:

Self Employed?

Yes

No

Years on Job?

Years in Field?

Position/Title:

Employers Phone #:

### - ### - ####

Monthly Income:

Co-Borrower Employment Information
Company Name & Address:

Self Employed?

Yes

No

Years on Job?

Years in Field?

Position/Title:

Employers Phone #:

### - ### - ####

Monthly Income:

Assets and Other Liabilities:

Checking / Savings
Retirement
Gift Funds
Monthly Auto Payments
Monthly Credit Card Payments
etc.

Add up all these Assets & Liabilities and fill in the total amount.

Have you had a Bankruptcy or Foreclosure in the last 7 years? If yes include Date of Discharge:

You are finished! Click SUBMIT

By clicking SUBMIT you authorize KMG Mortgage to verify the above information and to secure/pull all applicants personal credit report(s).