| PERSONAL
INFO |
| |
| NAME: |
|
| ADDRESS: |
|
| EMAIL: |
|
| TELEPHONE: |
|
| REFERRAL
AGENT: |
(who refers you) |
| |
| First
Mortgage Information |
| |
| Current
Value of Home: |
(don't
know?) |
| Mortgage
Balance: |
|
| Interest
Rate: |
|
| Remaining
Years to Payoff: |
|
| Total
Monthly Payment: |
|
| Monthly
Amount Paid to Escrow: |
|
| Loan
Type: |
|
| |
| Second
Mortgage Information |
| |
| 2nd
Mortgage Balance: |
|
| Interest
Rate: |
|
| Remaining
Years to Payoff: |
|
|
Monthly Payment: |
|
| Loan
Type: |
|
| |
| Income
Information |
| |
| Earner
#1 Net Income (after taxes, etc) : |
(don't
know?) |
| Earner
#1 Payment Schedule: |
|
| Earner
#1 Income Type: |
|
| Earner
#1 FICO: |
(don't
know?) |
| Earner
#2 Net Income (after taxes, etc): |
|
| Earner
#2 Payment Schedule: |
|
| Earner
#2 Income Type: |
|
| Earner
#2 FICO: |
(don't
know?) |
| |
| Discretionary
Income |
| |
Money
left over each month after paying expenses
(credit, entertainment, utilities, etc.): |
|
| |
| Additional
Information |
Additional Creditors
(Auto, Credit Card, etc.) — you may group Credit Card
obligations together. Be sure to include Credit Type (vehicle,
credit card, etc),
balance owing, monthly payment, interest rate and years remaining. |
| |
By completing
the fields on this web page you are requesting information
about the Money Merge Account (MMA) product with no obligation
on your part to purchase the MMA product or on our part to
offer the MMA product.
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|
