Pacific Coast Lending Loan Application Information Sheet The Information that you provide below will help us quickly process your mortgage application. The following items will give us easy access to the people that may be involved in helping us to get your loan funded quickly and efficiently.  To expedite processing, complete all fields that apply.  We suggest you complete as much information as possible.(* Required fields)

Select a Loan Officer:

Mark Klein David Gittelson Liz King Luigi Bordonaro Aaron Sattler (Other if not known or listed)

Borrower Information:

Last Name:*	Home Number:*
First Name: *	Home Fax Number: - -
Date of Birth: / /   mm/dd/yyyy	Cell Number:  - -		Pgr Number: - -
Social Security Number:*	E-mail:*		Drivers License:
Marital Status:   married single divorced	Work Number:  - -		Ext:

   

Co-Borrower Information:

Last Name :	Pgr Number: - -
First Name:	Cell Number: - -
Date of Birth: / /   mm/dd/yyyy	Work Number: - -	Ext:
Social Security Number: - -	E-mail:	Drivers License:

1) Who should be the primary contact for information:

2) When would be the best time to contact you? Home/Work AM/PM?

3) How would you like us to contact you? Phone/E-mail/Fax/Pager/Cell?

   

Family Information: Child’s Name: Date of Birth: / /   mm/dd/yyyy Child’s Name: Date of Birth: / /   mm/dd/yyyy Child’s Name: Date of Birth: / /   mm/dd/yyyy

   

Residence During Past 3 Years:

Current Address:

City:	State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip Code:
Rent/Own: Rent   Own	No. of Yrs.:	Monthly rent amount:

Current Annual Property Taxes:	HOA Dues:
Annual Hazard Insurance Premium:	Original Purchase Price:

Prior Address:

City:

State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Rent/Own: Rent   Own

No. of Yrs.:

Date from - Date to:

Prior Address:

City:

State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Rent/Own: Rent   Own

No. of Yrs.:

Date from - Date to:

Do you own any other properties? Yes   No

   

Current Landlord Information:

Name:

Street Address:

City:	State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip Code:
Phone Number: - -	Date from - Date to:

   

Borrower Employment Information: Current Employer: Title: Yrs. on Job: Yrs. in Profession: Street Address: City: State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code: Human Resource Contact: Phone Number: - - Fax Number: - - Net Worth of Business Owned: Prior Employer: Title: Yrs. on Job: Street Address: City: State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code: Phone Number: - - Human Resources Contact:

   

Co-Borrower Employment Information:

Current Employer:	Title:
Yrs. on Job:	Yrs in Profession:

Street Address:

City:

State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Fax Number: - -
Human Resource Contact:
Phone Number: - -	Fax Number: - -
Net Worth of Business Owned:
Prior Employer:	Title:
Yrs. on Job:	Yrs. in Profession:

Street Address:

City:

State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Phone Number: - -	Fax Number: - -
Human Resource Contact:

   

Assets:

Automobile owned: Make   Year	Value:
Automobile owned: Make   Year	Value:
Value of Personal Assets:

   

Additional Information: *On a scale of 1-10 (10 Being highest) how would you rate your satisfaction with the following?

1. Realtor

2.CPA

3.Financial Planner

4. Insurance Agent

Realtor-Buyer’s Insurance Agent Name: Name: Company: Company: Address: Address: City: State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: City: State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: Phone Number: - - Phone Number: - - Fax Number: - - Annual Hazard Ins. Premium(Fire):

Tax Consultant-Accountant Stock Broker-Fin. Planner Name: Name: Firm: Firm: Address: Address: City: State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: City: State: AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: Phone Number: - - Phone Number: - - Fax Number: - - Fax Number: - -

I agree.  By checking this button, I hereby give consent to have Pacific Coast Lending obtain information regarding my employment, credit and financial inquires, including but not limited to verification of employment forms and verification of mortgage forms. Also I authorize Pacific Coast Lending to obtain a confidential credit report solely for the purpose of determining my home loan qualifications. I Disagree.