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Call Me at: (516) 797-5740

Mortgage Information

Welcome to my Online Application Page, please fill in the information below and click on the submit and approve button, we will respond within 24 hours.

How did you find our web site
Purpose of Loan:
Property will be:
Number of units:
Property Address:
Street
City
State
Zip
Property Value: $
Loan Amount: $
Loan Type:
Interest Rate Requested: (%)

Please complete the information below for the borrower and co-borrower, if available:
	Borrower	Co-Borrower
First Name
Middle Initial
Last Name
Social Security Number
Home Phone (incl. area code)
Business Phone (incl. area code)
E-Mail Address
Present Address: if different from above
Street
City
State
Zip
Rent or Own?
Number of years
Years of Employment in current job
Years employed in current line of work/profession
Are you self employed?
Funds available for down payment, closings costs and reserves (estimated)

Income
	Borrower	Co-Borrower
Monthly Income
Other Annual Income
Do You Have a Printer (with legal paper)	Yes	No
Please enter any comments or questions here:

My e-mail address: Lazsold@aol.com

Call me Direct at:

(516) 797-5740

Re/Max Shores Realty

4110 Merrick Rd.

Massapequa, NY 11758

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