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Type of Loan

Home Description

Your Credit Profile

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Are you a first-time home buyer?
Yes No

Your Current Home Buying Situation

Home will be used for

Purchase price of the new home
$

Estimated Down Payment
$

Desired Type of Rate
Fixed Adjustable

Property Use

Purchase Year

Estimated Home Value
$

1st Mortgage Balance
$

1st Mortgage Interest Rate

1st Mortgage With

Existing Type of Rate
Fixed Adjustable

Do you have a 2nd Mortgage?
Yes No

2nd Mortgage Balance
$

2nd Mortgage Interest Rate

Desired Home Equity Loan or Line of Credit Amount

How much additional cash do you wish to borrow?

Age of Homeowner

Age of Co-Borrower

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Age Range

Employment status

Number of late mortgage payments in the past 12 months?

Any bankruptcy in the past 3 years?
Yes No

Any foreclosure in the past 3 years?
Yes No

Do you currently have an FHA loan?
Yes No I don't know

Can you show proof of your income?
Yes No

Property Address

Property City

Property State

Property Zip

Property Address:

Property City:

Property State:

Property Zip:

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Active or previous U.S. military service?
Yes No

Are you already a USAA member?
Yes No

Are you working with a Real Estate Agent?
Yes No

First Name

Last Name

Mailing Address

Mailing City

Mailing State

Mailing Zip

Request on behalf of:

Email:

Home Phone

Work/Cell

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United Mortgage Corp. \| 25 Melville Park Road \| Suite 100 \| Melville \| NY \| 11747 \| NMLS #1330 \| For company licensing NMLS Consumer Access: www.nmlsconsumeraccess.org
United Mortgage Corp is not acting on behalf of or at the direction of HUD/FHA or the Federal government.