Matthew Reiter
702.806.7879

Mini-Application
*First Name:
*Last Name:
*Age:
*Social Security Number:
(Type in with no dashes)
*Address:
*City:
*State:
*Zip Code:
*E-mail Address
(required for confirmation)
*Marriage Status Married
Single
Divorced

Co-borrower Full Name:

Co-borrower Social Security #:

Co-borrower Age:

Co-borrower Employer:

Co-borrower Yearly Income:

 $

*Home Phone:
*Work Phone:
Cell Phone:
Best Number/Time to reach you:

*Monthly Rent Amount:

$

Yearly Income:

*Hourly Wage or Yearly Salary: $

Reg. Overtime/Bonuses: $

Other income/monthly amount: $

*Who do you bank with?

*Average monthly balance?

$

Debt:

 

Car Loan(s)/Total Balance:   $

Car Loan(s)/Installment Loan(s)/Monthly Payment:
$

Credit Card Monthly Payment: $
Alimonty/Child Support :   $

Credit Condition:

Good
Average
Fair
Poor
Not Sure

Have you had a Bankruptcy in the last 7 years?
If yes, was it a chapter 7 or 13 and when was
it discharged?


Fill Out This Area Only If You Are Refinancing

Current market value of home

$

Amount owed on current loan?

$

Current Interest Rate

%

What are your goals?

 get lower rate
 get lower payment
 debt consolidation

Contact Me

If you have any other questions, please contact me at :

Matthew Reiter
702.806.7879