Lima Marketplace Mortgage Corp.

Please fill out this form with as much information as possible. An experienced loan officer will quickly be in touch with you in regards to your request.

How much house can you afford? The answer to this question is based upon several factors. First your own personal "financial comfort level" and secondly, your financial condition. You may qualify for a loan amount that is greater than you comfort level. Stay within your comfort zone.

Tell us about your new home:
Address:
City:
State, Zip:
	Amount of Loan	Type of Loan
	What is the appraised value?	This application is for a:

Tell us About Yourself / Borrower:
Borrower's Name
Borrowers Date of Birth	mm/dd/yyyy

Home Address (no P.O. boxes) (Street Address City, State, Zip)
E-Mail Address
	Home Phone Number	Work Phone Number
	Social Security Number	Base Monthly Income
	Place of Employment	How long employed there? yrs mos
	Have you had contact with a loan officer?	Employment Status

Co-Borrower:
Co-Borrower's Name
Co-Borrowers Date of Birth	mm/dd/yyyy

Home Address (no P.O. boxes) (Street Address City, State, Zip)
E-Mail Address
	Home Phone Number	Work Phone Number
	Social Security Number	Base Monthly Income
	Place of Employment	How long employed there? yrs mos
	Employment Status

Loan/Debt Information:

Car Note Amount	Credit Card Debt
Other Monthly Payments	How is your credit?
Are you current on your existing indebtedness?
Do you have outstanding liens or judgments?
May we run a preliminary credit check?

Do you have any special questions or concerns?