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Instructions

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

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

How did you find this web site?

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 ?

Yes

Length of Employment:

Gross Monthly Income:

Date of Birth:

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:

Primary

Second/Vacation

Investment

Purchase Amount:

Loan Information

Mortgage Balances:

Amount:

Held by:

Payment:

First:

Second:

Other:

Creators

Name

Amount Owed

Monthly Payment

Will be paid off?

Yes

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.