Which state is the property in?:

Number of Borrowers?:

Do you own this property?:

Has the property been listed for sale in the last 90 days?:

What is your email address?:

Product of Interest:

Last Name:

First Name:

Middle Initial:

Marital Status:

Street Address:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Extension:

How long have you been at this address?:

Employer:

Income:

How long in field of Work?:

Self Employment Income:

How long have you been self emplyed?:

Other Income:

Alimony, child support, or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.

How long have you been in your home?:

Purchase Price:

Current Property Value:

Owner Occupied:

Type of Home:

1st Mortgage Holder:

1st Mortgage Balance:

1st Mortgage Monthly Payment:

Includes Tax & Insurance?:

If not: Monthly Tax and Insurance:

2nd Mortgage Holder:

2nd Mortgage Balance:

2nd Mortage Monthly Payment:

The Federal Government requests the following information for certain types of dwelling-related loans in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish the information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it.
PRIMARY BORROWER:

Gender:

Race/National Origin:

I understand that by clicking the "I understand" button below and authorizing this submission, I am not obligated to open an account. 1st Nations Mortgage Corp. are authorized to check my credit, employment, and mortgage history, to make whatever other inquiries it considers necessary in connection with this request, and to disclose information about its credit experience with me.

All borrowers must be on the title to the property. All Co-borrower questions must be completed if another person will be jointly obligated on the loan. If you are interested in an individual account, but are (1) relying on income from alimony, child support, or separate maintenance, or on the income or assets of another person as a basis for repayment on the loan, or (2) if you are married and reside in a community property state, or (3) if the property is located in a community property state, complete the Co-borrower questions to the extent possible. Even if you are married, you may Pre-Qualify for an individual account. Alimony, child support, or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.

Washington residents: Notify us if we should investigate your credit references and/or credit history under another name.

Please note: The information you submit via this form is used to help us better assess your mortgage needs. Your application will not be considered complete and your rate will not be locked until you you have received and completed our mortgage application package. If you would like to lock-in your rate immediately, contact a Loan Officer at 1st Nations Mortgage Corp.

I understand that by clicking below that I consent to the terms of this authorization.