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Form

If you are interested in pre-qualifying for a loan to purchase a new home or refinance your existing mortgage, apply for an Equity Line of Credit or No Equity 125% Debt Consolidation 2^nd Loan, please fill in the following information so that we can respond to your request as quickly as possible. You may fax this information to us at (209) 632-3267. You can be assured that this information will be held in the strictest confidence and will only be used for the purpose of assisting our loan officers to develop the best loan program to fit your individual needs. Feel free to leave some areas blank, although the lack of information will affect the ability to give you an accurate qualification. Please answer the following questions for our program evaluation:

Please provide the following contact information:

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First Name:						Please provide the borrower's first and last name in the boxes to the left.
Last Name:

Street Address:						Please provide the borrower's street address, city, state, and zip code.
City:					State:
Zip Code:

Home Phone:						Please provide the borrower's home and work phone numbers beginning with their respective three digit area code. Also, please provide the borrower's fax number and email address.
Work Phone:
FAX Number:
Email Address:

First Name:						Please provide the co-borrower's first and last name in the boxes to the left.
Last Name:

Home Phone:						Please provide the co-borrower's home and work phone numbers beginning with their respective three digit area code. Also, please provide the co-borrower's fax number and email address.
Work Phone:
FAX Number:
Email Address:

Primary	Secondary				Investment	Please indicate the type of loan you are interested in.

First			Second			Please indicate your lien position.

Purchase		Cash-Out Refi		No Cash-Out Refi		Please indicate the purpose of the loan.
Construction			Construction-	Other -
			Permanent

Appraised Value:						Please indicate the appraised value of the property.

Loan Amount:						Please indicate the desired loan amount.

Street Address:						Please provide the subject properties address.
City:					State:
Zip Code:

Borrower's Monthly Income:						Please provide the borrower and co-borrower's gross monthly income.
Co-Borrower's Monthly Income:

Borrower's other income:						Please provide the borrower and co-borrower's other monthly income.
Co-Borrower's other income:

Property tax:						Please provide the borrower and co-borrower's monthly property tax and insurance expenses.
Insurance:

Form

Great Central Mortgage Corporation Last revised: June 02, 2003

Great Central Mortgage Corporation
Last revised: June 02, 2003