Please print & complete all applicable fields then fax this form to 305-256-1171
Borrower: _______________________
Address: _________________________
_________________________________
Years you have lived here: _______
SSN: _____--- ______---________
Phone H: ( )____________________
Phone W: ( )____________________
Fax: ( )____________________
Email: ________@__________._____
Birth Date: _____ /______ /19____
Driver’s License #:______________
Employment
Employer: _________________________
Address:___________________________
Years with:__________
Position____________________________
Income & Assets
Salary: $_____________
Bonus/Com $_____________
Other Income: $_____________
Savings/Checking: $________________
Which Bank? ____________________
401k/IRA/ESOP: $________________
Current Home(s)
Pmt: $_____________
Current rate ___________%
Pending Sale? YES or NO
Balance: $_____________
Do you have a Home Equity? ________
Current Home Value: $_____________
Other properties owned: YES or NO
Address: _______________________
Address: _______________________
Type: Rental 2nd home Land
About Your New Purchase:
Unit #_____________________________
Price: $____________________________
Desired Down Pmt: $/%_______________
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Co Borrower: ______________________
SSN: _____--- ______---________
Phone W: ( )____________________
Birth Date: ____ /_____ /19____
Driver’s License #:______________
Employment
Employer: _________________________
Address:___________________________
Years with: __________
Position ___________________________
Income
Salary: $_____________
Bonus/Com $_____________
Other Income: $_____________
Important Questions
Amount you’d like to borrow $__________
Do you want a line of credit? YES or NO
Do you want escrows? YES or NO
Are you a US Citizen? YES or NO
Are you self employed? YES or NO
To Charge Application Fee of $375
Credit Card #______________________
Type: MC Visa
Expiration Date: ______________
___We look forward to helping you and will call you within 24 hours. Please fax to: (305) 256-1171. If you have questions call (305) 662-5011.
___ I, the undersigned consumer, direct Paramount Bank to request & obtain a copy of my/our consumer credit report. This consent shall automatically expire in 30 days from the date of my/our signature.
X______________________Date______
X______________________Date_______
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