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"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
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.: $
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
Have you found the particular home you want to purchase? Yes No
Purchase Price: $ Down Payment: $
Source Of Funds: Proposed Closing Date:
Seller Concession: %
Name: Name:
Phone: Phone:
Income: $ Income: $
Self Employed? Self Employed?
Position: Years: Position: Years:
Additional Income: $ Additional Income: $
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.