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  • Use this form to request mortgage information.
  • Please fill out as much of this form as possible.
  • When finished click the "Submit Form" button.
  • If you prefer to speak to a loan officer please call 508.453.4766

Notice: Filling out this form does not lock in, nor guarantee rate protection of any kind.  Loan applications must be confirmed verbally with a representative.

Please call us at the above number to lock-in rate and/or to have us answer any of your questions. A loan officer may contact you. A phone number is required.

Mortgage Captain, LLC. Secure Loan Application

 

The information you enter on this form will be kept in strict confidence and will not be shared with any third parties.
 


 

Mortgage Type:
1st 2nd Home Equity
Amount Requested:
$

 
 
Property To Be Financed (if known)
Address:
Apt. or Unit# :
How Many Units
City:
State:
Zip:
 

IF REFINANCING FILL OUT THE FOLLOWING INFORMATION

When did you purchase? yr. mo.
What was the original purchase price? $
What do you think it is worth today? $
Do you own other properties?

Yes No

If so how many?
Existing Mortgages 1st Mortgage 2nd Mortgage
Please enter below the monthly information for:
  Mgt. Balance $ $
Taxes & Insurance Monthly Mortgage 
(Are taxes and insurance included in your payment? Yes)		 $ $

 


IF PURCHASE FILL OUT THE FOLLOWING INFORMATION
When do you expect to purchase?
yr.   mo.  
When will home be completed?
yr.   mo.  
What is the purchase price?
$
What is your down payment?
$ (Enter 0 for 100% financing)
Do you own other properties?

 
Yes No
 If so how many?

 
Personal Information
  Applicant Co-Applicant
First Name
Last Name
Social Security Number
Date of Birth
Home Phone
Work Phone
How would you rate your credit?
Are you married to the
Co-Applicant?		  
Best time to contact you?
E-Mail 

 
Current Address
Did you?
How long?
 yrs.   mo
Address:
 
Apt. or Unit# : Monthly Payment
City:  
State:  
Zip:  
Previous Address  (if less than 2 yrs. at current)
Did you?
How long?
 yrs.   mo
Address:
 
Apt. or Unit#: Monthly Payment
City:  
State:  
Zip:  



Employment History

  Applicant Co-Applicant
Employer Name
Gross Annual Income*
Your Position (title)
Self-Employed Yes No Yes No
Length with Company
yrs. mos.
yrs. mos.
Phone Number


 

Previous Employer   (if less than 2 yrs. at current)

Employer Name
Gross Monthly Income
Your Position
Length of time with Company yrs. mos.
yrs. mos.
Phone Number


 
Asset Information Applicant Co-Applicant
Checking Account Bank Name
Checking Average Balance
Savings Account Bank Name
Savings Average balance
Retirement Account Balance
Other Assets

Comments / Additional Details


By submitting this on-line application, I/We authorize Mortgage Captain, LLC to check such information as my/our credit, business and employment status and history. Submitting this application does not lock-in rate. Please call us at 508.453.4766 if you have any questions. Thank You.

 

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