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Applicant(s) Info
Applicant's Name 
Title 
 Mr Mrs Ms 
E-Mail 
Home Phone 
Work Phone 
Best Time to Call 
Home Address 
City / State / ZIP 
 
Co-Applicant's Name 
Title 
 Mr Mrs Ms 
E-Mail 
Home Phone 
Work Phone 
Best Time to Call 
Home Address 
City / State / ZIP 

Employment & Income Info
Applicant's Employer
Monthly Income 
Years w/ this Employer 
* If less than 2 years, include previous employer

Applicant's Previous Employer 

Applicant'sPrevious Employer Monthly Income

Years w/ Previous Employer 

 
Co-Applicant's Employer 
Monthly Income 
Years w/ this Employer 
* If less than 2 years, include previous employer

Co-Applicant's  Previous Employer 

Co-Applicant's Previous Employer Monthly Income

Years w/ Previous  Employer 

Loan Info

Type of Loan 

Purchase Price of Property 

 Type of Property 

***** If this Loan is for Refiance or Debt Consolidation, please fill out the following ****

How long have you owned the property?  Estimated Home Value 
 
First Mortgage Balance 

Monthly Payment 

Annual Taxes & Insurance Costs 

Are Taxes / Insurances Included in Monthly Payment?
Yes No

Interest Rate: 

 Second Mortgage Balance 

Monthly Payment 

Interest Rate: 

Credit History & Income Info

How would you rate your credit? 

Have you been 30 days (or more) late on your mortgage? Yes No 

Is your mortgage current now? Yes No

Are you Self-Employeed? Yes No

If you currently rent, how do you pay that rent? Check   Money Order   Cash

How are you paid? Check 1099 W-2 Cash Tips
 

Credit Report Authorization
Do you authorize Ameritime Mortgage Company to check your credit report?
(Type "Yes" or "No")

Primary Applicant Social Security No.

Co-Applicant Social Security No. 
(if applicable)

Comments / Clarifications

Ameritime Mortgage Company - Warren E. Wnek, Branch Manager
2850 Lake Washington Road #2        Melbourne, FL 32935
Local Phone (321) 751-7887        Toll Free (866) 751-7887      Fax (321) 751-7881