Reverse Mortgage Application

Note: This is an application, and not yet binding to either party.

The Property:

Street Address
Street Address 2 (Optional)
City
State
Zip
Value of Property
Primary Residence. I live here or am buying this to move into here.
2nd / Vacation Home.
Rental / Flip / Investment Property

Property is Held in These Names (List All Names on Property Title, or Name of Trust):



Held via... This property is also held as Inter Vivos (Living) Trust (do not check if unsure)

The Borrower(s):

Borrower

Name:
Phone:
E-mail:
Social Security # will be required but requested offline (via Phone or Mail) for Security.
Date of Birth (MM/DD/YYYY)
Monthly Income:
Real Estate Assets $
Available Liquid Assets:
Home Phone (including area code):
Years Living at This Address:
Mailing Address if Different:
City, State, Zip:
Marital Status:
Alternate Contact Person
Name
Phone:

Co-Borrower (Optional)

Name:
Phone:
E-mail:
Social Security # will be required but requested offline (via Phone or Mail) for Security.
Date of Birth (MM/DD/YYYY)
Monthly Income:
Real Estate Assets $
Available Assets:
Home Phone (including area code):
Years Living at This Address:
Mailing Address if Different:
City, State, Zip:
Marital Status:
Alternate Contact Person
Name
Phone:

Liens Against Subject Property (Required to be Paid Off)

Lender Name Type Address of Lender Balance
Total

Total Non-Real Estate Debt

Lender Name Type Address of Lender Balance
Total

Declarations:

Borrower Co-Borrower
  Yes No Yes No
Are there any outstanding judgements against you?
Have you filed for any bankruptcy that has not been resolved?
Are you party to a lawsuit?
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? [If "Yes", give details including date, name and address of lender, FHA or VA Case number (if applicable), and reason for delinquency/default]
Do you intend to occupy the property as your primary residence?
Are you a co-maker or endorser on a note? (Optional for HUD)
Are you a U.S. citizen? (Optional for HUD)
Are you a permanent resident alien? (Optional for HUD)