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Loan Request Form

Rate Inquiry and Loan Assistance Form

Contact Information
Full Name: Your full name Address: Your mailing address street and number
Phone: Your phone number (we do not telemarket!) City: Your mailing address city
Fax: Your fax number (we do not faxblast!) State: Your mailing address state
E-mail: Your email address (we do not spam!) Zip: -Your mailing address zipcode

Property Information and Purpose of Loan
Loan Type: Purchase
Refinance
Construction 		Loan Purpose: Primary Residence
Secondary Residence
Investment
Property Address: The property's address Original Cost $: Original/actual cost of home
Property City: The property's city Existing Liens $: Existing lien amounts
Property State: The property's state Present Value $: Present value of the property
Property Zip: -The property's zipcode    

Borrower and Employment Information
Borrower's Name: Borrower's full name CoBorrower's Name: Co-borrower's full name
Social Security #: Borrower's social security number (optional) Social Security #: Co-Borrower's social security number (optional)
Phone Number: Borrower's Phone Number Phone Number: CoBorrower's Phone Number
Date of Birth: Borrower's date of birth Date of Birth: Co-borrower's date of birth
Status: Single
Married
Separated 		Status: Single
Married
Separated
Holdings: Own
Rent 		Holdings: Own
Rent
Employer: Borrower's employer Employer: Co-borrower's employer
Position/Title: Borrower's title Position/Title: Co-borrower's title
Employer Phone: Borrower's employer's phone number Employer Phone: Co-borrower's employer's phone number
Mthly Income $: Borrower's gross monthly income Mthly Income $: Co-borrower's gross monthly income
Mthly Expenses $: Borrower's monthly expenses Mthly Expenses $: Co-borrower's monthly expenses
Accounts: Checking
Savings
Both 		Accounts: Checking
Savings
Both
Bank Name: Borrower's bank name Bank Name: Co-borrower's bank name


Thank you for your interest in Valley West Mortgage!  


Form Assistance
If you require assistance completing this form, please call (702) 696-9900 or e-mail info@valleywestmortgage.com.

Rates Subject to Change
Interest rates are highly subject to change. Once we have received your application, we will start the process of aggressively finding the best possible rate. Please note, as interest rates are time sensitive, our ability to provide you with the best possible loan requires you to be available and quick to provide property detail, verification of employment, and other documentation that may be required.

Privacy Information
The information you provide here is for rate inquiry and loan application purposes only. Your privacy and security is important to us. Our servers are secured by a top-rated provider that handles thousands of sensitive transactions a day. We will not sell or use the information provided here for anything other than rate inquiry and loan request purposes. We do not spam or fax blast.

Submitting this form in no way obligates you to utilizing our services. We will not pull credit without your verbal authorization.

Social Security Numbers
Providing the "Borrower's" and "Co-Borrower's" social security numbers is optional. However, it will greatly speed up the process and enable us to provide you with a faster rate. Also note, we will never run your credit without your prior verbal authorization.
© 2004-2008 Valley West Corporation. All Rights Reserved.
5506 S Fort Apache Rd, Suite #110, Las Vegas, Nevada 89148