Mortgage Inquiry

Please complete the following form.

A Loan Officer will contact you.

*=Required Fields

Basic Information

*Please briefly tell us how you heard about us:

*Mortgage Type:
*Loan Type:

Borrower Information

*First Name:

M.I.:

*Last Name:

*Birthday:

Co-Borrower Information

First Name:

M.I.:

Last Name:

Co-Birthday:

Location and Contact Information

*Address Line 1:Address Line 2:

*City:*Zip:

*State:

*Home Phone:

Work Phone:

*Email Address:

Best time to contact you:

Property Information

*City:

*State:

*Property Type:

Purchase Information (if applicable)

Price Range: $

to $

Down Payment Amount: $

Down Payment Source:

Refinance Information (if applicable)

Occupancy Type:

Estimated Property Value:

1st Mortgage Value: $

2nd Mortgage Value: $

Loan Type:

Interest Rate: %

P & I

Taxes / Insurance:

Mortgage Insurance:

Additional Comments

If you have any additional information that may be helpful to us in evaluating your loan please let us know here:

IMPORTANT INFORMATION ABOUT PROCEDURES
FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

Mortgage Inquiry

IMPORTANT INFORMATION ABOUT PROCEDURESFOR OPENING A NEW ACCOUNT

IMPORTANT INFORMATION ABOUT PROCEDURES
FOR OPENING A NEW ACCOUNT