JMS Mortgages Inc. Application Form

Lexon Mortgages Plus Broker License: 12768

Please fill out the entire form as detailed as possible before you click submit at the bottom of the page.

Personal

Main Applicant

Name

S.I.N.

Date of Birth (yyyy/mm/dd)

Dependants

Marital Status

Current Address

Number of Years at current address

Residential/Cellular Phone Number

Email

Previous Address (if current less then 3 years)

Number of Years at previous address

Current Employer

Number of Years at current employer

Gross Anual Income $

Occupation

Business Phone Number of current employer

Previous Employer (if current less then 3 years)

Number of Years at previous employer

Gross Anual Income $

Occupation

Business Phone Number of previous employer

Co-Applicant

Co-Applicant Name

S.I.N.

Date of Birth (yyyy/mm/dd)

Dependants

Marital Status

Current Address

Number of Years at current address

Residential/Cellular Phone Number

Email

Previous Address (if current less then 3 years)

Number of Years at previous address

Current Employer

Number of Years at current employer

Gross Anual Income $

Occupation

Business Phone Number of current employer

Previous Employer (if current less then 3 years)

Number of Years at previous employer

Gross Anual Income $

Occupation

Business Phone Number of previous employer

Other

Other Household Income

Source of the income

Gross Income $

Financial Net Worth $

Assets

Principal Residence

Rental/Other Properties

Cash

Any Other Assets

Total Assets

Liabilities Total Debt

Principal Residence

Rental/Other Properties

Credit Cards

Credit Lines/Loans

Liabilities Total Debt

Liabilities Monthly Payment

Principal Residence

Rental/Other Properties

Credit Cards

Credit Lines/Loans

Liabilities Total Monthly

Property Description

Municipal Address

Square Feet

Age of the property

Owner Occupied

Zoning

Lot Size

Garage Size

Garage Type

Heating Type

Taxes $

Condo Fee $

Heating $

Existing Mortgage/Properties

First Mortgage

1st Mortgage Information

Held By

Mortgage Number

Property Value

Interest rate in %

Amount Remaining $

Maturity Date (yyyy/mm/dd)

Payment $

Payment Frequency

Second Mortgage

2nd Mortgage Information

Held By

Mortgage Number

Property Value

Interest rate in %

Amount Remaining $

Maturity Date (yyyy/mm/dd)

Payment $

Payment Frequency

I/We warrant and confirm that the information given in the mortgage application form is true and correct and I/We understand that it is being used to determine my/our credit responsibility. Lexon Mortgages Plus/ Enrich Mortgage Group/ DLC Producers West Financial is authorized to obtain any information you may require relative to this application from any sources to which you may apply and each such source is hereby authorized to provide you with such information. Lexon Mortgages Plus/ Enrich Mortgage Group/ DLC Producers West Financial is furthermore authorized to disclose, in response to direct inquiries from any other lender or credit bureau, such information on my loaning accounts as you consider appropriate, and I agree to indemnify Lexon Mortgages Plus/ Enrich Mortgage Group/ DLC Producers West Financial against and save you harm from any and all claims in damages or otherwise arising from such disclosure on your part. Lexon Mortgages Plus/ Enrich Mortgage Group/ DLC Producers West Financial is also authorized to retain the application whether or not the relative mortgage is approved.

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