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MORTGAGE INFORMATION

We use this form solely for the purpose of mortgage qualification. Once filled out, it will remain strictly confidential. The information will be used to quickly verify your credit rating. This form is secure, so please provide the following information to the best of your ability to help us get started on finding the best mortgage for you. There is no cost, obligation or commitment by submitting this form.

Applying For *

Term *

Amortization *

Property Value ($) *

Down Payment ($) *

Down Payment Source *

Down Payment Explanation

Property Value ($)

Please note: In order to qualify for a zero down mortgage you must have a minimum of two (2) years full time employment and have a clean credit history.

Current Property Value ($)

Available Equity ($)

Applicant Information

Title

First Name *

Last Name *

Birth Date (yyyy-mm-dd)

S.I.N.

Marital Status *

Dependents *

Home Phone *

( )

Cell Phone

( )

Work Phone

( )

Ext.

E-mail Address

Preferred Method *

Current Address *

City *

Province *

Postal *

How Long? *

Applicant Employment Income

Annual Income ($) *

Employment Status *

Current Employer *

Occupation *

Employment Address

City

Province

Postal

How Long? *

Extra Income Sources (Excluding Rental Property)

Add Extra Income

Co-Applicant Information

Remove Applicant

Title

First Name *

Last Name *

Birth Date (yyyy-mm-dd)

S.I.N.

Marital Status *

Dependents *

Home Phone *

( )

Cell Phone

( )

Work Phone

( )

Ext.

E-mail Address

Preferred Method *

Current Address *

City *

Province *

Postal *

How Long? *

Co-Applicant Employment Income

Annual Income ($) *

Employment Status *

Current Employer *

Occupation *

Employment Address

City

Province

Postal

How Long? *

Extra Income Sources (Excluding Rental Property)

Add Extra Income

Add Co-Applicant

Vehicle Assets

Vehicle Value ($)

Year

Make

Model

Outstanding ($)

Payment /month

Vehicle Value ($)

Year

Make

Model

Outstanding ($)

Payment /month

Property Assets

Property Value ($)

Value Type

Condo Fees

Property Tax

Heating Cost

Rental Income

Ownership

Outstanding

Lender

Maturity Date

Rate

Payment Frequency

Payment

Property Address

City

Province

Postal

Property Value ($)

Value Type

Condo Fees

Property Tax

Heating Cost

Rental Income

Ownership

Outstanding

Lender

Maturity Date

Rate

Payment Frequency

Payment

Property Address

City

Province

Postal

General Assets

Asset Value ($)

Type

Description

Asset Value ($)

Type

Description

Asset Value ($)

Type

Description

Asset Value ($)

Type

Description

Asset Value ($)

Type

Description

Asset Value ($)

Type

Description

Liabilities

Outstanding ($)

Type

Payment (monthly)

Outstanding ($)

Type

Payment (monthly)

Outstanding ($)

Type

Payment (monthly)

Outstanding ($)

Type

Payment (monthly)

Outstanding ($)

Type

Payment (monthly)

Outstanding ($)

Type

Payment (monthly)

Client Comments

(Please provide any additional information which could help us with your request)

Referrer

(Please enter the person or organization, if any, that referred you to this form)

By filling out this secure application, I hereby authorize Access Mortgage Inc to obtain a credit report and make any necessary inquiries regarding my mortgage application and to release this information to any approved lender who may be willing to provide funds on my behalf as stated in the Access Mortgage Inc Privacy Policy.