Simply fill out the form below to apply for a home mortgage. Required fields are marked with the asterisk sign(*).

Your application is subjected to approval and you will be notified as soon as a decision has been made. Thank you for choosing VisionQwest.

APPLICANT NAME*:
First name	M.I.	Last name
CO-APPLICANT NAME:
First name	M.I.	Last name
ADDRESS*:
Lot/Block no., Street City State Zipcode
CONTACT NUMBERS*:
Day Phone Evening Phone Mobile Phone Fax Number
E-MAIL ADDRESS*:
EMPLOYMENT*:
$ Applicant Job Title Yrs of service Monthly Salary
$ Co-Applicant Job Title Yrs of service Monthly Salary
TOTAL MONTHLY INCOME (Combined monthly salaries if two applicants)*:
TOTALCREDIT CARD DEBT*:
TOTAL MONTHLY DEBT*:
CREDIT HISTORY*:
APPLICANT Rate credit level Excellent Good Fair Poor Credit challenged Remarks  CO-APPLICANT Rate credit level Excellent Good Fair Poor Credit challenged Remarks
LOAN TYPE NEEDED*: Choose one Purchase Re-finance Re-finance w/ Cash out Home Equity Loan HELOC Line of Credit MORTGAGE TYPE*: Choose one Fixed Rate Adjustable(ARM) Interest only Jumbo loan($350k ++)          FHA VA TYPE OF PROPERTY*: Choose one Single Family Condominium Duplex Triplex Multi-unit Investment              Other DURATION OF LOAN*: Choose one 10 years 15 years 20 years 30 years          Other PURCHASE AMOUNT: $ RE-FINANCE AMOUNT: $ HELOC AMOUNT: $ PROPERTY VALUE*: $ If re-finance, what will be your preferred interest rate on your current loan amount?   % If you are purchasing a home, how long is your escrow & expected close date?   wk/mos
OTHER RELEVANT INFORMATION:
TO BE FILLED OUT BY A VISIONQWEST AGENT VQ CallCenter Agent  Agent Name  Client Code