CoastalHomeLoans.com Secure Mortgage Loan Application

We also offer a printable application that can be filled out and faxed or mailed to us CLICK HERE.

If you are working with one of our mortgage loan officers please enter his/her name here:

Desired Loan Amount:

Please Select A Loan Type:

 

Home Purchase Price Of Home  (sales price or price range considering)

Mortgage Refinance Home's Value  1st Mortgage Balance   Interest Rate  Monthly Payment Does this payment include taxes & insurance? YES   NO 2nd Mortgage Balance (if applicable)

Second Mortgage Home's Value  1st Mortgage Balance  2nd Mortgage Balance (if applicable)

Borrower Information:

Borrower (Full Name): Date of Birth: (ex. dd/mm/yyyy) Soc. Security #: Residence Phone #: (including area code) Cell Phone #:  (including area code) Business Phone #: (including area code) Present Address: City: State: Zip Code: E-mail Address Years at Present Address:      Rent /$month (or) Own /$month Give previous address if at current address less than 2 years: Previous Address: City: State: Zip Code: Marital Status: Married Separated Unmarried (including single, divorced, or widowed)     Occupation:    (Position & Title) # of years: Place of Employment:   (Name & Address) Previous Employer:    (Name & Address)

Co-Borrower Information: (you may use the word "same" for co-borrower info that is the same as borrower's)

Co-Borrower (Full Name): Date of Birth: (ex. dd/mm/yyyy) Soc. Security #: Residence Phone #: (including area code) Cell Phone #:  (including area code) Business Phone #: (including area code) Present Address: City: State: Zip Code: E-mail Address Years at Present Address:   Rent /$month (or) Own /$month  Give previous address if at current address less than 2 years: Previous Address: City: State: Zip Code:   Marital Status: Married Separated Unmarried (including single, divorced, or widowed)   Occupation:    (Position & Title) # of years: Place of Employment:    (Name & Address) Previous Employer:    (Name & Address)

Gross Annual Income:
	Borrower Co-Borrower Self-Employed ? Yes    No Yes    No Base Salary:  $ $ Overtime: $ $ Bonuses: $ $ Commissions: $ $ Dividends: $ $ Net Rental Income: $ $ Other: $ $   Total: $ $   Do You Intend To Occupy This Property ?    Yes     No Number of Children: Ages: Other Dependents:

Assets:
	Checking: $  Bank:     Checking #2 $  Bank: Savings: $  Bank:     Savings #2 $  Bank: Credit Union: $  Bank: Stocks: $ Bonds: $ Life Insurance: $   Present Residence  (If Owned): Market Value: $ Mortgage Balance: $ Lender:   Other Assets (Specify):

	Are There Any Judgements or Lawsuits Present?   Yes   No  Amount:  $ Is Any Part of the Down Payment or Settlement Costs Being Obtained From a Source Other Than From Assets Listed Above?   Yes   No I hereby give my consent to have my credit report secured from any credit reporting agency which you designate.   Yes   No If you are ready to send the form to us check here and click Submit.