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AMWMG Logo

Company NMLS #: 122171

107 North State Road 135 Suite 301

Greenwood, Indiana 46142

(317) 882-2255

Customer Questionnaire

Please Select One of the Following:*

I would like to purchase a home I would like to refinance a home I would like to do a reverse mortgage

PRIMARY APPLICANT INFORMATION

Legal Name*

First Name*

Last Name*

Social Security Number*

Date of Birth*

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Month

Day

Year

Primary Phone*

Alternate Phone

Email*

Current Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Estimated Property Value* $

At Current Address Do You?*

Rent Own

Will You Be Selling Home Prior to Closing?

Yes No

Monthly Payment* $

Are Taxes & Insurance Included in Monthly Payment?

Yes No

Are Taxes & Insurance Included in Mortgage Payment?*

Yes No

Annual Property Taxes* $

Annual Home Insurance* $

First Mortgage Balance* $

First Mortgage Percentage Rate*

Do you have a Second Mortgage*

Yes No

Second Mortgage Balance* $

Second Mortgage Percentage Rate*

Length of Time at Current Address*

Less than 2 years More than 2 years

Previous Address

Address Line 1

Address Line 2

City

State

ZIP Code

Length of Time at Previous Address

At Previous Address Did You?

Rent Own

Name of Current Employer*

Job Title*

Monthly Gross Income* $

Start Date of Employment*

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Month

Day

Year

Employer Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Employer Phone*

Length of Time at Current Employer*

Less than 2 years More than 2 years

Name of Previous Employer

Previous Job Title

Previous Monthly Gross Income $

Start Date of Previous Employment

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Month

Day

Year

End Date of Previous Employment

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Month

Day

Year

Previous Employer Address

Address Line 1

Address Line 2

City

State

ZIP Code

Previous Employer Phone Number

Current Bank Account(s) Balance* $

(Enter Combined Total for All Checking & Savings)

Purchase Price of Home* $

Loan Amount Seeking* $

Refinance Purpose*

Additional Comments/Notes

Is There a Co-Applicant?*

Yes No

I THE UNDERSIGNED AM APPLYING FOR A MORTGAGE LOAN WITH APPROVED MORTGAGE. AS PART OF THE APPLICATION PROCESS, I AUTHORIZE APPROVED MORTGAGE TO PULL **CREDIT IN ORDER TO EVALUATE MY MORTGAGE OPTIONS.

Signature*

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*By submitting contact information through this form, I agree that Approved Mortgage and its affiliates may call, email, and/or text me about its offerings by any phone number or email that I have provided and may provide in the future, including any wireless number, using automated technology. Message and data rates may apply. **Approved Mortgage offers one free soft pull for each client's Transunion credit report to evaluate mortgage options. The Client will be responsible for the cost of Equifax and Experian reports at the time of credit pull if proceeding with loan application.

CO-APPLICANT INFORMATION

Legal Name*

First Name*

Last Name*

Social Security Number*

Date of Birth*

https://distancelearningsystemsinc.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Primary Phone*

Alternate Phone

Email*

Current Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Estimated Property Tax Value* $

At Your Current Address Do You?*

Rent Own

Will You Be Selling Your Home Prior To Closing?

Yes No

Monthly Payment* $

Are Taxes & Insurance Included in Monthly Payment?

Yes No

Are Taxes & Insurance Included in Mortgage Payment?

Yes No

Annual Property Taxes* $

Annual Home Insurance* $

First Mortgage Balance* $

First Mortgage Percentage Rate*

Do You Have a Second Mortgage?*

Yes No

Second Mortgage Balance* $

Second Mortgage Percentage Rate*

Length of Time at Current Address*

Less than 2 years More than 2 years

Previous Address

Address Line 1

Address Line 2

City

State

ZIP Code

Length of Time at Previous Address

At Previous Address Did You?

Rent Own

Name of Current Employer*

Job Title*

Monthly Gross Income* $

Start Date of Employment*

https://distancelearningsystemsinc.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Employer Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Employer Phone Number*

Length of Time at Current Employer*

Less than 2 years More than 2 years

Name of Previous Empoyer

Previous Job Title

Previous Monthly Gross Income $

Start Date of Previous Employment

https://distancelearningsystemsinc.formstack.com/forms/images/2/calendar.png

Month

Day

Year

End Date of Previous Employment

https://distancelearningsystemsinc.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Previous Employer Address

Address Line 1

Address Line 2

City

State

ZIP Code

Previous Employer Phone

Current Bank Account(s) Balance* $

(Enter Combined Total For All Checking & Savings)

Additional Comments/Notes

I THE UNDERSIGNED AM APPLYING FOR A MORTGAGE LOAN WITH APPROVED MORTGAGE. AS PART OF THE APPLICATION PROCESS, I AUTHORIZE APPROVED MORTGAGE TO PULL **CREDIT IN ORDER TO EVALUATE MY MORTGAGE OPTIONS.

Co-Applicant Signature*

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Use your mouse or finger to draw your signature above