Loan Connectors- Customer Survey


	Loan Application

Please complete the following application:

Personal Information:
First Name:
Last Name:
Email Address:
Address:
City:
State:
Zip:
Preferred Contact Time:
Preferred Contact Phone Number:

Loan Information :
Loan Type:
Estimated Home Value or Purchase Price:		$
Balance of Current Loan/s (include all mortgages on property)		$
Current Rate on Your 1st Mortgage:
Requested Loan Amount:		$
Purpose of Refinance:
Do You have a Prepayment Penalty?:
Is Your Current Mortgage an Adjustable Loan?
If so, When will it Adjust Next?
Down Payment (home purchase only)
How would You Describe Your Credit History?
Have You Declared Bankruptcy within the Last 3 Years?
If so, when was it discharged?
Have you had a Foreclosure within the last 5 Years?
How did you hear about us?
Comments: Tell us about what you are trying to accomplish, your financial needs or anything else you think we should know!

22935 Lyons Ave #F
Newhall, CA 91321

Tel.: (661) 295-0555
Toll Free: (877) 295-1555
Fax: (866) 587-5005