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We at Mortgage Discount Warehouse Inc. would like to thank you for your interest in our company and our services. We strive to obtain our customers by providing the the best possible rates along with quality service.

Application for a Mortgage Secured Loan

APPLICANT	CO-APPLICANT
Name:	Name:
e-mail:	e-mail:
Phone #:	Phone #:
SS#:	SS#:
Address:	Address:
City:	City:
State: ZIP:	State: ZIP:

Do you own a house? ....if yes, please detail below.

How long have you owened it? years

Approximate Home Value:

Current amount of liens on property:

EMPLOYMENT INFORMATION

APPLICANT

Employer:

Address:

City:

State: ZIP:

Year Employed: Monthly Income:

CO-APPLICANT

Employer:

Address:

City:

State: ZIP:

Year Employed: Monthly Income:

LOAN INFORMATION

Purpose of the Loan:

Home Purchase	Debt Consolidation
Re-finance for lower Rate	New Construction Purchase
Home Improvement	Tax deductable line of credit
Purchase of Rental Property	Other?

Best time to contact you:

Phone Number:

Time:

I allow Mortgage Discount Warehouse Inc., an Illinois Residential mortgage licensee, to process a credit check to help procure a real-estate secured loan.

(Please type I Agree)

THE BEST POSSIBLE RATES ALONG WITH QUAILTY SERVICE!