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Ivey Mortgage
Applicant Information
Name:
Date of birth:
SSN:
Phone:
Current address:
City:
State:
ZIP Code:
Own Rent (Please circle)
Monthly payment or rent:
How long?
Previous address:
City:
State:
ZIP Code:
Owned Rented (Please circle)
Monthly payment or rent:
How long?
Employment Information
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly Salary (Please circle)
Annual income:
Previous employer:
Address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly Salary (Please circle)
Annual income:
CO-APPLICANT INFORMATION, IF FOR A JOINT ACCOUNT
Name:
Date of birth:
SSN:
Phone:
Current address:
City:
State:
ZIP Code:
Own Rent (Please circle)
Monthly payment or rent:
How long?
Previous address:
City:
State:
ZIP Code:
Owned Rented (Please circle)
Monthly payment or rent:
How long?
Employment Information
Current employer:
Employer address:
How long?
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly Salary (Please circle)
Annual income:
Previous employer:
Address:
Phone:
E-mail:
Fax:
City:
State:
ZIP Code:
Position:
Hourly Salary (Please circle)
Annual income:
Asset Information
Account No.1
Account No.2
Type of Account:
Type of Account:
Name of Bank:
Name of Bank:
Average Balance:
Average Balance:
Property Information
PROPERTY No.1
I DO DO NOT RESIDE IN THIS PROPERTY (Please circle)
Phone:
City:
State:
ZIP Code:
Appraised Value:
Amount of 1st Mortgage Lien:
Name of Mortgage Company:
Amount of 2nd Mortgage Lien:
Name of Mortgage Company:
Name of Insurance Company:
Name of Agent:
Phone No.:
PROPERTY No.2
I DO DO NOT RESIDE IN THIS PROPERTY (Please circle)
Phone:
City:
State:
ZIP Code:
Appraised Value:
Amount of 1st Mortgage Lien:
Name of Mortgage Company:
Amount of 2nd Mortgage Lien:
Name of Mortgage Company:
Name of Insurance Company:
Name of Agent:
Phone No.:
PROPERTY No.3
I DO DO NOT RESIDE IN THIS PROPERTY (Please circle)
Phone:
City:
State:
ZIP Code:
Appraised Value:
Amount of 1st Mortgage Lien:
Name of Mortgage Company:
Amount of 2nd Mortgage Lien:
Name of Mortgage Company:
Name of Insurance Company:
Name of Agent:
Phone No.:
I authorize Ivey Mortgage to verify the information provided on this form and to obtain my credit report.
Signature of applicant
Date
Signature of co-applicant, if for joint account
Date
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