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Loan Information Form

A loan offficer will contact you. A phone number is required.

General Information
	Borrower	Co-borrower (if different)
Full Name:
Street Address:
City:
State & Zip:
Home Phone:
Work Phone:
Best Time to Contact:
E-mail:
Social Security #:
Employer:
Employer's Phone:
Are you self-employed?	Yes No	Yes No
Length of Employment:
Gross Monthly Income:	$	$
Date of Birth:
My credit history is:	excellent good, but some lates some credit problems major credit problems don't know	excellent good, but some lates some credit problems major credit problems don't know

Loan Request
Amount Requested:
Type of Loan:

Property Information (This information needs to be filled out for property that is collateral for the loan)
Street Address:
City, State & Zip Code:
Estimated Present Value:
Year Purchased:
Original Price:
Type of Property:	Primary Secondary/Vacation Investment
Purchase Amount:

Loan Information
Mortgage Balances	Amount:	Held by:	Payment:
First	$		$
Second	$		$
Other	$		$

Creditors	Amount Owed	Monthly Payment	Will you pay this off?
	$	$	Yes No
	$	$	Yes No
	$	$	Yes No
	$	$	Yes No
Other monthly debts and information - please describe


How did you find out about this web site?
By submitting this on-line application, I/we authorize BALTCOR REAL ESTATE FINANCE to check such things as my/our credit, business and employment status and histories. Please review the information you've filled out and, when finished, hit the "Submit Request" button only once.