Atlantic Home Equity Mortgage

Borrower		Co-Borrower
First Name		First Name
Middle		Middle
Last Name		Last Name
Primary Residence Address
Street		State
City		Zip Code
Contact Information
Day Phone		Evening Phone
Email		Best time to contact?
Loan Information
Property Type	Loan Purpose	Estimated Value	Estimated Loan Amount
Primary Residence Investment Property Second Home Vacation Home Other	Purchase Refinance 2nd Mortgage Line of Credit Other	$ of loan property	$
Your Credit
How would you rate your credit?		Have you ever filed Bankruptcy?	Yes No

Additional Information
Please provide any additional information in the space below

*** The purpose of this application is to provide the foundation for a more detailed interview with one of our loan officers. Loan approvals require program specific documentation, satisfactory underwriting, appraisal, credit check, and title. You will be contacted by a loan officer within one business day of your submission.