Quantum Merit Mortgage

The information you enter on this form will be kept in strict confidence.

PLEASE DO NOT USE DOLLAR SIGNS ($) OR COMMAS ( , )
WHEN ENTERING NUMBERS.

	Mortgage Type:	1st 2nd Home Equity
	Amount Requested:	$

Property To Be Financed (if known)
Address:	Apt. or Unit# :
City:	State:	Zip:

IF REFINANCING FILL OUT THE FOLLOWING INFORMATION and then continue with Form

When did you purchase?	yr. mo.
What was the purchase price?	$
What do you think it is worth today?	$
Do you own other properties?	Yes No	If so how many?

Existing Mortgages		1st Mortgage	2nd Mortgage
Please enter below the monthly information for:	Mgt. Balance	$	$
Taxes & Insurance Monthly Mortgage (Are taxes and insurance included in your payment? Yes)		$	$

IF PURCHASE FILL OUT THE FOLLOWING INFORMATION

When do you expect to purchase?	yr. mo.
When will home be completed?	yr. mo.
What is the purchase price?	$
What is your down payment?	$
Do you own other properties?	Yes No	If so how many?

Personal Information
	Applicant	Co-Applicant
First Name
Last Name
Social Security Number
E-Mail
Home Phone
Fax
How would you rate your credit?
Are you married to the Co-Applicant?
Best time to contact you?

If purchase address is different than the property address
Did you?	How long?	yrs. mo
Address:	Apt. or Unit# :
City:	State:	Zip:

Current Address (if less than 2 yrs. at current) or If Purchase Actual Address.
Did you?	How long?	yrs. mo
Address:	Apt. or Unit# :
City:	State:	Zip:

Employment History

Applicant

Co-Applicant

Employer Name

Gross Monthly Income*

Your Position (title)

Self-Employed

Yes No

Length with Company

yrs. mos.

Phone Number

Previous Employer (if less than 2 yrs. at current)

Employer Name

Gross Monthly Income

Your Position

Length of time with Company

yrs. mos.

Phone Number