Citizens Fidelity Mortgage

Express Application
(Albany/Leesburg Office)

Borrower's Name:
Birth Date: (mm/dd/yy)
Email Address:
Social Security Number: (Optional, but needed for credit check and pre-approval)
Co-Borrower's Name:
Birth Date: (mm/dd/yy)
Social Security Number: (Optional, but needed for credit check and pre-approval)
Home Address of Current Residence:

Address of Home Being Financed (if different):

Home Phone:
Work Phone:
Monthly Income Before Taxes: (Combined if Co-Borrower)
Are you self-employed?	Yes No
Length of Employment: Borrower: Co-Borrower:
Purchase Information
Contract Price:
Amount of Loan Requested:
Anticipated Closing Date:
Refinance Information
Fair Market Value:
Amount of Present Loan:
Present Interest Rate:
Do you want cash out?	Yes No
Credit Inquiry Authorization I/we hereby give our consent to have Citizens Fidelity Mortgage, Inc., or any credit reporting bureau which it may designate, obtain any and all information concerning our/my bank accounts, obligations, and all other credit matters which they may require in connection with my/our application for a mortgage loan. Returning this application by electronic transfer signifies my agreement.
Do you agree to the above terms?	Yes No
Loan Officer Preference? (Please fill in loan officer's name)
Please feel free to enter any extra comments below:

At Citizens Fidelity Mortgage we offer many home loan mortgage programs. Together with the assistance of an experienced, "live" loan officer to guide you through the often difficult and confusing process of choosing and getting the exact home loan mortgage to meet your specific needs.