Nesli Orten Direct : 321.438.0815 Fax : 407.876.1320 Licensed Mortgage Broker nesli@perfidia.us

APPLY FOR A LOAN Fill out the information below and a loan professional will contact you to review your free credit report and answer any questions you might have regarding your new loan! Let us help you buying you home. (Fields marked as * are mandatory.) Primary Borrower Information *First Name *Middle *Last Name * Social Security Number : * Date of birth : 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 *Phone : Cell Phone : *Work Phone : Fax : *e-Mail : Co-Borrower Information Co-Borrower Type: Please select if neededJointSeperate First Name Middle Last Name Social Security Number : Date of birth : 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Phone : Cell Phone : Work Phone : Fax : e-Mail : Please enter current mailing address of the Borrower/Buyer: Property Street Address : City : State : Zip : Country : Time at residence: years What is your monthly provable income from all sources? Please enter the address of the property to be purchased (not required). Property Street Address : City : State : Zip : Country : How much will the down payment be? What is the source of down payment (ex. savings account, gift from relatives etc.)? Borrower own funds Immediate family gift funds Other family gift funds Non-family gift funds Seller All other sources How will you use the property? Please select Primary Residence Secondary Residence Investor Property What is the appraised value of the property you wish to purchase? What is the sale price of the property you wish to purchase? What is the loan amount that you are seeking? What is the purpose? Please select Construction to permanent Construction Purchase Refinance What is the first position loan amortization type? Please select Regular amortized ARM Balloon Interest only ARM Fixed Growth equity mortgage Graduated Payment ARM Graduated Payment Mortgage Options adjustage ARM Rules of 78 Reverse Mortgage Step What is the first position loan amortization term? Please select 5 yr 10 yr 15 yr 20 yr 55 yr 30 yr 35 yr 40 yr What type of documentation will be available for this loan? Please select Full Documentation Alternative Documentation Stated assets with no verification of income or employment Stated assets and stated income with verification of employment Stated income with verification of assets and employment No income and no assets with verification of employment No ratios with verification of assets and employment No documentation of assets,income and employment What is your employment status? Please select Full Time Part Time Self-Employed Retired Unemployed What is the property type? Please select Single Family Residence Low Rise Condo High Rise Condo Single Wide Mobile Double Wide Mobile Manufactured Land Developed Lot Rural Townhome Condo-tel How many units does the property contain ? Please select 1 2 3 4 5 6 7 8 9 10 Comments: