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Instructions

  1. Use this form to request mortgage information.
  2. Please fill out as much of this form as possible.
  3. When finished click on the send button.

Robert McCormick will contact you. A phone number is required.

General Information

Borrower
Co-borrower

(If different)

Full Name:

Address:

City, State, Zip:

Home Phone:

Best time to contact:

E-mail:

Social Security #:

Employers:

Employers' Phone Number:

Are you self employed ?

Length of Employment:

Gross Monthly Income:

Date of Birth:

My credit history is:

Loan Request

Amount Requested:

Type of loan:

Property Information

*This information needs to be filled out for the property that is collateral for the loan

Street Address:

City, State, Zip Code:

Estimated Present Value:

Year Purchased:

Original Price:

Type of Property:

Purchase Amount:

Loan Information

Mortgage Balances:

Amount:

Held by:

Payment:

First:

Second:

Other:

Creators

Name

Amount Owed

Monthly Payment

Will be paid off?

$

$

$

$

$

$

$

$

Other monthly debts and information - please describe

By submitting this on-line application, I/we authorize Mortgage Quest a dba of McCormick Lending Group, Inc. to check such things as my/our credit, business and employment status and histories.