Mortgages, Refinance, Home Equity Loans

"Quik Form" Loan Application-Realtor Version *Required Field
Realtor Name*	Business Name*
Business Phone*	Business Fax
"Quik Form" Loan Application *Required Field
Are you a homeowner? Yes, No	.
Amount Requested* $	Purpose Of Loan
Applicant	Co-Applicant
First Name*	First Name
Last Name*	Last Name
Social Security Number: --	Social Security Number: --
Home Phone:*	Home Phone:
Work Phone:*	Work Phone:
Property Information*
Owner Occupied, Investment Property
Subject Address
Street:*	State:*
City:*	Zip Code:*
Names On Deed:*
Yearly Taxes:* $	Ins.: $
Refinancing
Orig. Purchase Date:	Orig. Purchase Price: $
Present Market Value: $
1st Mortgage Balance: $	2nd Mortgage Balance: $
1st Mortgage Holder:	2nd Mortgage Holder:
Interest Rate:%	Interest Rate:%
Current Payment: $ Years Remaining:	Current Payment: $ Years Remaining:
Include Taxes and Insurance? Yes No	Include Taxes and Insurance? Yes No
Purchases
Have you found the particular home you want to purchase? Yes No
Purchase Price: $	Down Payment: $
Source Of Funds:	Proposed Closing Date:
	Seller Concession: %
Employment
Name:	Name:
Phone:	Phone:
Income: $	Income: $
Self Employed?	Self Employed?
Position: Years:	Position: Years:
Additional Income: $	Additional Income: $
Other
Comments:
E-Mail*:	Best Time To Call:
How Did You Find Our Site?	.
* I/We hereby give our consent to First Millennium Funding, Inc and any credit bureau designated to obtain any and all information concerning our employment, checking and/or savings account, obligations and all other credit matters which they may require in connection with our application for a mortgage loan. This form may be reproduced or photocopied and a copy shall be as effective consent as the original which we have submitted.