Mortgage Application
If You would like to purchase a property and need a home mortgage or would like to refinance your current mortgage or take cash out please reply to the following questions in the e-mail box below or fax to (516) 833-5098 and one of our Mortgage specialists will get back to you. (*anything you feel uncomfortable filling in please do not, please just call us instead)
Applicants Name:__________________________________Date of Birth:_________________________
Address:______________________________________________________________________________
City:____________________________State:_________________________Zip:____________________
Home#:______________________________Cell:_____________________E-Mail:__________________
Co-Applicants Name:__________________________________Date of Birth:______________________
Address:______________________________________________________________________________
City:____________________________State:_________________________Zip:____________________
Home#:______________________________Cell:_____________________E-Mail:__________________
Mortgage Information:
1st Mortgage:
Balance :____________
Payment :___________
Interest Rate:________
Years Left :__________
2nd Mortgage:
Balance :____________
Payment :___________
Interest Rate:________
Years Left :__________
Loan Purpose:
Cash Out:_________________________________Credit Cards:________________________________
Rate & Term:__________________________________Other:__________________________________
11 Middle Neck Road, Suite 201
Great Neck, NY 11021
Office : (516) 280-5100
Fax : (516) 833-5098