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Leland Financial Services, Inc.

Your Full Service Mortgage Company

Residential Mortgage Request Form

Borrower   SS#
Spouse   SS#
Home #     Work #      Ext
City    State     Zip

Property & Debt Information

Estimated Current Market Value of Home
Estimated Mortgage Balance on 1st   2nd
Estimated Monthly Payment on 1st   2nd
Current Mortgage Rate on 1st %    
Current Mortgage Rate on 2nd %    
Total Debts: Car     Credit Cards     Other

Prospect Requests

Borrowers Objective
Type of Loan
Cash Amount Requested
     If Other, please specify
What do you want the money for?

Employment Information

Position or Occupation
Borrower Total Monthly Income
Spouse Occupation
Spouse Total Monthly Income

Optional Additional Questions (OAQ's)

How do you rate your credit?   
Have you ever filed for bankrupcy?        If yes, when?



fatpat Software · PO Box 1785 · Charlottesville, VA 22902 · (804) 977-1652