Viva Mortgage

Useful Tools:

How did you hear about us?

Who referred you ?

Applicant & Co-Applicant Information:

Applicant First Name

Middle Init.

Applicant Last Name

Home Phone

Work Phone

SSN

E-Mail

Age

Years of Schooling

Co-Applicant First Name

Middle Init.

Co-Applicant Last Name

Home Phone

Work Phone

SSN

E-Mail

Age

Years of Schooling

Current Address

City

State

Zip

Do you own or rent this property?

Number of Years

Gross Income:

1.	Applicant Employer Position Years on Job Years in same field	Monthly Income Amt. $
	Co-Applicant Employer Position Years on Job Years in same field	Monthly Income Amt. $
3.	Other Income Applicant	Monthly Income Amt $
4.	Other Income Co-Applicant	$

Total Gross Monthly Income:		$

Assets:

1.	Cash Deposit (Type of Account)	Amount $
2.		$
1.	Checking and Savings Accounts Financial Institution	Amount $
	Account Number
2.	Financial Institution	Amount $
	Account Number


1.	Stocks and Bonds (Please Describe)	Amount $
2.		$
3.		$


1.	Life Insurance	Face Amount $

1.	Automobile Type	Est. Value $
2.		$
3.		$


1.	Other Assets (Please Describe)	Amount $
2.		$
3.		$
4.		$

Housing Expenses:

		Monthly Pymt
1.	1st Mortgage	$
2.	Property Taxes	$
3.	Home Owners Insurance	$
Total Monthly Housing Expenses:		$

Monthly Debts:

Type of Loan Requested:

Best way to contact me is:

by:

Comments:

62 School St.,Glen Cove, NY 11542
Tel. 516-676-9010 | 1-888-276-VIVA(8482)