Vivienda Propia Mortgage - Loan Request Form

Vivienda Propia Mortgage

Loan Request Form

Please complete and submit the following Loan Request Form for an immediate review and response. We will send you a savings analysis detailing how much money you will save each month. We will also send you an early loan pay-off schedule and much more. It's fast, it's easy, and it's free. There is absolutely no obligation on your part.


Are you a home owner?	Yes No
Are you planning to buy a home in the next six months?	Yes No
Amount requested:	$
Type of Loan:	Purchase Refinance 2nd Mortgage Equity Line	Home Improvement Debt Consolidation Other


First mortgage balance:	$ Fixed Adjustable
First mortgage current interest rate?	. %
First mortgage payment:	$
Does that include taxes and insurance?
Do you have a second mortgage?	Yes No
If so, how much?	$
Second mortgage current interest rate:	. %
When did you get it?
What type of property?
Is there anyone else on the title of the property?	Yes No
Estimated value:	$



	Borrower	Co-Borrower
First Name:
Middle Initial:
Last Name:
Suffix:
Address 1:
Address 2:
City:
State:	Zip:

Home Phone:
Work Phone:
Best time to call:
Best place to contact:
Best person to contact:	Borrower	Co-Borrower
Best phone number to call:
E-mail:
Social Security Number:


	Borrower	Co-Borrower
Employer
Self-employed?	Yes No	Yes No
Length of employment:
Gross monthly income:
Date of Birth
My credit history is
Ever filed for bankruptcy?	Yes No	Yes No

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, the lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below.
Please fill out either section 1 or 2 below.
1.	Borrower	Co-Borrower
I do not wish to furnish this information
2.
Hispanic or Latino:	Yes No	Yes No
Race:
Sex:	Male Female	Male Female

Please enter any comment or special request you may have:

Where did you hear of us?

The undersigned applicant(s) authorize(s) Vivienda Propia Mortgage to obtain all necessary information to complete the approval process. Necessary credit information may include: employment history, savings and checking records, consumer credit reports, as well as payment history - including mortgage payment records and balances. I (we) understand that there are NO upfront application fees, however depending on the loan program in which we qualify, a property appraisal may be required.