Confidential Information Request

When you complete this form you agree to be contacted only by UXP Mortgage Corp. for the sole purpose of helping you to find the absolute best mortgage available. Your information is used only to help obtain your loan and will not be shared with anyone for any other purpose, we know you have many choices and appreciate your confidence. (see privacy policy)

Just take 2 minutes to fill out our secure confidential information request below. You will be contacted within 2 to 24 hours, or possibly sooner by one of our licensed professional mortgage consultants to go over your options at no cost or obligation.

information in red is required, and estimates are OK

LOAN REQUEST
What kind of loan would you like:
How much would you like to borrow:		$
Loan purpose:

BORROWER INFO
Name: (first, last)
Home phone:		(000) 000-0000
Email address:
Work phone: (if applicable)		(000) 000-0000 ext123
Please rate your credit:
Best person to contact:
Best time to call:
Employment:
Time on job:
Gross monthly income: (not all loans require income verification)

CO-BORROWER INFO
Name: (first, last)
Email address:
Work phone:		(000) 000-0000 ext123
Please rate your credit:
Employment:
Time on job:
Gross monthly income: (not all loans require income verification)

PROPERTY INFO
State:
Home value: (estimate ok)		$

CURRENT LOAN INFO
First mortgage balance:		$
First mortgage interest rate:		%
Is first mortgage a fixed or adjustable rate?
First mortgage payment:		$
Do you have a second mortgage?		yes no
Second mortgage balance: (if applicable)		$
Second mortgage interest rate: (if applicable)		%
Second mortgage payment: (if applicable)		$

CURRENT LOAN NEEDS
I'm ready to start the application process:
I'm interested in working with a competitive lender:
I am just checking rates to see if a loan makes sense:
I am only interested in rates and am not looking for a loan at this time:

COMMENTS