Mortgage Application Request

Please fill out the following form to request an application to be sent to you from Discount Mortgage. Once you have completed this expression of interest or application, your information will be sent to Discount Mortgage. A representative from Discount Mortgage may contact you by telephone or email. By submitting your expression of interest you are consenting to receive telephone calls or email from Discount Mortgage.

CONTACT AND BORROWER INFORMATION

First Name

Last Name

Email Address

Current Street Address

City

State

Zip Code

Primary Phone

Alternate Phone

Best Time To Call

Would you like to provide loan information?

Yes

LOAN AND PROPERTY DETAILS

Time with Current Employer

Credit History

Loan Type

Years Months

Are you Self Employed?

Monthly Income

Monthly Debt

Yes

Loan Amount

Program

Time Frame

Property Value

Intended Use

Property Type

Property Street Address

City

State

Zip Code

COMMENTS