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  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.

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General Information

Borrower Co-borrower
(If different)
Full Name:
City, State, Zip
Home Phone:
Work Phone:
Best time to contact:
Social Security #:
Employers' Phone Number:
Are you self employed ? Yes No Yes No
Length of Employment:
Gross Monthly Income:
Date of Birth:
My credit history is: excellent
good, but some lates
some credit problems
major credit problems
don't know
good, but some lates
some credit problems
major credit problems
don't know

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
Held by:


Name Amount Owed Monthly Payment
Will be paid off?
$ $ Yes No
$ $ Yes No
$ $ Yes No
$ $ Yes No

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.

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AZMB#0903631 / CFL #603J043 / CO ID #20161226406 / NMLS #175743

Toll Free: (800) 328-0144 Fax: (888) 570-6740

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