Fax 281-500-4067 Short Form Mortgage Application Mini-1003 Page 1 of 2 DATE TIME LOAN OFFICER PURPOSE OF LOAN REFINANCE PURCHASE CONSTRUCTION EQUITY LINE PRIMARY BORROWER DOB //19 SSN -- PHONE H - PHONE W - PHONE C - CO-BORROWER DOB //19 CURRENT ADDRESS House No. Street City State Zip FOR PURCHASE LISTED HOME HOME TYPE SINGLE FAMILY DUPLEX MULTIPLEX TOWNHOME CONDO EST. MARKET VALUE HOME ADDRESS Y CASH OUT Y / N N AMOUNT REASON S FOR CASH YEAR PURCHASED YEAR BUILT ORIGINAL COST HOW LONG IN...
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