Referral:—Please choose an option—TammyCarieDustinJessicaFacebookInstagramGoogle (or other search engine)Other
If other please specify:
Purpose of Loan—Please choose an option—Pre-approved Mortgage LoanMortgage Loan for New HomeSecond MortgageRefinance/ConsolidateTransfer/SwitchConstructionInter Alia MortgageOther
Full Name
S.I.N.
Dependants
Marital Status
Month—Please choose an option—JanFebMarAprMayJunJulAugSeptOctNovDec
Day
Year
Present Address
City
Postal Code
Rent/Own($)
No. of Years
Previous Address if less than 3 years
Home Phone:
Cellular:
Bus Phone:
Email:
Current Employer
Occupation
Employer Phone #
Years
Gross Annual Income
Income type—Please choose an option—salaryhourly
Employer Address
Employer Postal Code
Previous employment if less than 3 years
Other Income: Source
Income
Gross Business Income $
Net Business Income $
Desired Purchase Price $
First Time Buyer?—Please choose an option—YesNo
Down Payment
Down Payment Source—Please choose an option—own resourcesfamily giftRSP
Bank:
Type:
Balance: $
RRSP:
Value: $
Stocks/Bonds/GIC:
Automobile (year/make/model):
Other Assets:
Do you have Life Insurance? If yes, Policy Coverage $:
Do you have Disability Insurance?—Please choose an option—YesNo
Address:
City:
Property Value: $
Existing Mortgage Bank/Lender:
Mortgage Balance: $
Monthly Payments: $
Mortgage Rate: %
Mortgage Renewal Date:
Rental Income: $
Property Tax: $
Condo Fees: $
Second Mortgage Balance: $
Type:—Please choose an option—RentalSecond ResidenceVacation Property
I would prefer to be contacted by:—Please choose an option—E-mailTelephoneNo preference
Do you provide permission to be contacted via E-mail—Please choose an option—YesNo
I, (First Name), (Last Name) and (Co-Applicant First Name), (Co-Applicant Last Name) understand approval is subject to satisfactory home appraisal, verification of employment and credit report. I realize that DLC National (Harmony Mortgage Group) will base mortgage pre-approval on the information I have supplied on this form, so I verify that it is complete and correct. I consent to DLC National (Harmony Mortgage Group) obtaining credit information about me at any time. To indicate your acceptance of the terms explained above, please click Apply.
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