Note to be in the name of:
Borrower * and Co-Borrower
Current Home Address:
City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:
Phone *:
Email:
Rent Own Years: Month:
Is your current home listed for sale? Yes No
Address on listed property (if known):
Will this home be a primary residence, second home, or investment property: Primary residence Second home Investment property
Estimated purchase price *: Please Choose ------------- $100,000 - $300,000 $301,000 - $600,000 $601,000 - $1 million Greater then $1 million
Estimated Loan: $
Do you want to escrow for Taxes and Insurance: Yes No
For refinance only – do you want to roll closing costs into your loan: Yes No
Term of mortgage requested: years
Type of mortgage: ARM Fixed
How long do you anticipate you will live in this home: years
How were you referred to SealSolid program:
