Lender Intake Form

Borrower(s) Name(Required)

First Name

Middle Name

Last Name

Date of Birth

Property Address(Required)

Street Address City State ZIP Code

Current Address

Street Address City State ZIP Code

Borrower's Email

Borrower's Phone Number

Closing Date(Required)

Dwelling Usage(Required)

Is this loan a new purchase or refinance?(Required)

Will the Property Require Flood Insurance?(Required)

Loan Type(Required)

Do you have a copy of the elevation certificate?(Required)

Please note that an elevation certificate is needed for FHA and most government loans

Will the Insurance be Escrowed(Required)

Would you like us to send the quote directly to this client?(Required)

Email Address of Recipient(Required)

Lending Partner Contact Information

Name

Phone

If you have any documentation like an elevation certificate, quote comparison, etc, upload them here

Drop files here or

Max. file size: 98 MB.

If you have any other information to provide, please leave them here, thank you!