JMS Mortgages Inc. Application Form Lexon Mortgages Plus Broker License: 12768Please 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. I agree to the Terms of Service of this site. As well I agree to the Terms and Conditions of this form. Please prove you are human by selecting the Truck.