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Borrower
Co-Borrower
First Name
Last Name
Social Security Number
Date of Birth
Marital Status
Married
Unmarried
Seperated
Married
Unmarried
Seperated
Present Address
Street
City
State
Zip
Own or Rent?
Own
Rent
Own
Rent
How long have you been at this address?
Previous Address(if less than 2 years)
Street
City
State
Zip
Home Telephone Number
Work Telephone Number
Monthly Income
Are you currently an Elite customer?
Yes
No
Reason for requesting a loan?
Refinancing
Purchasing a Home
New Construction
Purchasing a New Toy
Consolidating Bills
About the Loan You are Requesting
Type of Home you Own
--
Single Family Residence
Condominium
Multiple Family Residence (up to 4 units)
Multiple Family Residence (5 or more units)
Mobile Home
Co-Op
Estimated Value of Home
$
Estimated Amount Owed on Home
$
Desired Loan Amount
$
About the Home You Would Like to Purchase
Type of Home
--
Single Family Residence
Condominium
Multiple Family Residence (up to 4 units)
Multiple Family Residence (5 or more units)
Mobile Home
Co-Op
Estimated Purchase Price
$
Estimated Amount of Down Payment
$
Do you have a Real Estate Agent?
Yes
No
Have you Already Selected a Home?
Yes
No
I/We hereby authorize Elite Mortgage & Financial Services to pull my.our credit, and verify that the above information submitted with this request is true and accurate.
Yes
No