Greg, David & The Team is proud to be partnered with Mortgage Broker Chuck Kansy

Your Full Name
 

Street Address
 

City   State    

Zip  

Home Phone:     Cell Phone:

Work Phone:    Other Phone:

Email Address  

Purchase Price (if you are buying this home)   $

Est. Value of Your Home (If You're Refinancing) $

Loan Amount (the amount you wish to borrow) $

Will this loan be placed on your:
Primary Residence
Vacation Home
Rental Property

Your current monthly salary from all sources: $

Your monthly commissions or bonuses averaged for the last two years, if any. $

Your total liquid assets i.e. checking, savings, stocks, bonds, IRA's, CD's, money market accounts, 401K plans, etc. that have been under your control for at least the last 90 days.
$