Residential and Commercial Mortgage Solutions!
818 Rt. 202-206, Bridgewater, N.J. 08807
Telephone (908) 722-9217 • Fax (908) 722-2827
Toll Free 800-327-0123 • Email: info@goldmortgage.com

Purchase / Refinance Form

Borrower Name:

Borrower Social Security Number:    

Co-borrower Name: 

Co-borrower Social Security Number: 

Current Address:
Street:
City: State: Zip:
Daytime Phone (include area code):
Home Phone:
Fax: Email:

Purpose Of The Loan:

Pre-qualification Purchase, I have found a property, need a mortgage Debt Consolidation Refinance

Address Of Property:
Street:
City: State: Zip:

Regarding The Mortgage:
1.  A) Purchase:  want to buy a home in the price range of:
         Low $$ High $$

     B) Refinance:

         appraised value           

         desired mortgage amount     

2. Type of Mortgage Desired:

30 year fixed 15 year fixed 10/1 ARM 7/1 ARM 5/1 ARM 3/1 ARM 1 year ARM COFI Loan I don't know, please advise

3. I want to make a down payment of $$

0 3% 5% 10% 15% 20% 25% more than 25% I'm not sure

4. Credit Type:

Perfect Credit Credit Card Lates (2 or less 30 days in past 12 months) Credit Card Lates (2 lates more than 30 days in past 2 years) Mortgage Lates (less than 3,  30 days in past 24 months) Mortgage Lates (more than 2, 30 days late in past 24 months) Mortgage Late less than 120 days Current Foreclosure Bankruptcy  Chapter 7 ( 1 day to 1 year old) Bankruptcy Chapter 7 (1 - 2 years old) Bankruptcy Chapter 13 (1 day to 1 year old) Bankruptcy Chapter 13 (1 to 2 years old) Bankruptcy (over 2 years old) Other

5. Gross Monthly Income:

	Borrower	Co-Borrower
Monthly Wages:
Monthly Bonus:
Other Monthly Income:

6. Monthly Payments On Non-Housing Debt:

Installment Loans:
Credit Card Payments:
Other Monthly Obligations:

7. I have found a Realtor®

Agent Name:
Agent Company:
Agent Phone:

8. I need to be put in touch with a Realtor® at a reduced commission in
City: State:

Comments/Credit Explanation/Special Requirements:

When you have filled out the form and are ready to send us your request, select "Submit Form" below. Thank you for your interest. We will contact you shortly!