Online Mortgage Application

Applicant Info:

These basic pieces of information will allow us to contact you to continue the application process. An email will be sent to the address you provide containing important contact information.

Start here:
* I am interested in:	PurchasingRefinancing
Have you spoken with a Loan Specialist?	YesNo	If yes, with whom?
* Your First Name:		* Your Last Name:
* Email:		Date of Birth:
* Day Phone:		Cell Phone:
* Mailing Address:		Address 2:
* City:		* State:
* Zip:		Years at present address:	(Round to nearest whole year. Use "1" for 0-11 months)

Employment Info:

Employment data is key information for qualifying for a loan. Please use this area to tell us about your current work status.

Self Employed?	YesNo	Company or Employer Name:
Years at Current Job:		Years in Line of Work:
Annual Base Income:		Avg Bonus/Commission:

Loan Info:

Understanding your goals and/or progress with a home loan lets us know how to guide you best to the next step and to a successful close. Use this area to tell us about your loan.

Estimated Purchase Price:		State where purchase will be made:
Amount available for down payment:
Do you currently have a contract on a home?	YesNo	Do you currently own a home?:	YesNo
Are you working with an experienced Realtor you trust?	YesNoNot Sure Not sure:
Is this Realtor one of Dave Ramsey's ELP Realtors?	YesNo
In order for our Loan Specialist to coordinate with your Realtor, please provide their contact information here:
Realtor's Name:
Realtor's Email:
Realtor's Phone:	(use format: 888-888-8888)
Any additional info:

Co-Applicant Info:
(optional)

This area provides us with information about an additional person on the loan. Only the applicant will receive a confirmation email. If applicable, please provide information about the co-applicant.


Co Applicant First Name:
Co Applicant Last Name:
Co Applicant Date of Birth:
Co Applicant Self-Employed?:	YesNo
Employer/Business Name:
Years at Current Job:
Years in Current Line of Work:
Annual Base Income:
Average Annual Bonus/Commission:

Mortgage Planning:
(optional)

At Churchill, good business is about making the customer aware of his or her options. We approach a loan with the heart of a teacher while providing great products for our customers. Use this space to tell us about your current and future financial goals and we will show you the most helpful methods to seeing them realized.


Financial Goals
What is most important about this mortgage to you?:
Which personal goals are most important?:
How long do you plan on living in the house?:
How much is your current mortgage/rent payment?:
What mortgage payment do you feel comfortable making?:
Is your household budget currently working?:
Do you have an emergency fund?:
What is your preferred balance for that account?:
What is the current balance for that account?:
Do you expect any of the following in the next 5 years?
A new child?
College expense?
Change in work time?
New or Replacement Vehicle
Do you have a strategy to handle these expenses?

Finished!

By submitting this form, I/we understand Churchill Mortgage Corporation and/or their Preferred Provider for our area and/or The Churchill Agency will receive the above information to assist in obtaining a home loan. I/we also authorize Churchill Mortgage Corporation, The Churchill Agency and/or their Preferred Provider for our area to obtain a credit report from a credit reporting agency, and to contact us regarding mortgage and insurance services and products. The submission of this form does not constitute in any way a formal loan application or a commitment for a loan.

*Applicant Full Name:

Online Purchase and Refinance Application