Reverse Mortgage Enquiry Form

1

What province are you located in?* This field is required.Select your province from the drop-down

2

What is your name?* This field is required.

First Name

Last Name

3

Email Address

example@example.com

4

Phone number* This field is required.

Area Code

Phone Number

5

Most of our clients like to communicate via Text and WhatsApp for quick confirmation and updates, what's your preference?💬* This field is required.Check all that apply

Yes - Text Messages

Yes - WhatsApp

No - Text Messages

No - WhatsApp

6

Retirement Status* This field is required.

I am currently retired

I am not retired

I plan on retiring within 5 years

7

What type of mortgage solution are you looking for?* This field is required.

Reverse Mortgage

Second Mortgage (Private)

Equity Mortgage

USA Mortgage for Canadians

Paused Payments Mortgage

8

Why are you looking to pause payments?* This field is required.

Temporary cash flow needs

Retirement income planning

Business or self-employment income gap

Medical or family situation

Strategic — investing the difference

Other

9

How long do you anticipate needing the payment pause?* This field is required.

Under 1 year

1–2 years

2–5 years

Open-ended

Not sure

10

What's your current monthly mortgage payment?* This field is required.

11

Are you currently on time with your payments, or behind?* This field is required.

On time

Behind 1–2 months

Behind 3+ months

In default proceedings

12

Are you also looking to access additional equity, or strictly pausing payments on the existing balance?* This field is required.

Strictly pausing payments

Also need additional equity

Not sure yet

13

Are you aged 55+?* This field is required.

YESNO

14

Mortgage amount required?* This field is required.

15

How familiar are you with reverse mortgages?* This field is required.

I'm not familiar with reverse mortgages at all

I'm somewhat familiar with reverse mortgages

I'm very familiar with reverse mortgages

16

Would you like additional resources or education about mortgages and home equity options?* This field is required.

YESNO

17

Do you currently have a mortgage on the property?* This field is required.

YESNO

18

What is the current mortgage amount/Line of credit amount owing on your property?Include all mortgages and HELOCs

19

Are you looking to receive:* This field is required.Select all that applies

A lump sum

Monthly payments

Not sure yet

20

When are the funds required?* This field is required.

Less than 30 days

30-45 days

45-120 days

Unsure

22

When are the funds required?* This field is required.

Less than 30 days

30-45 days

45-120 days

Unsure

23

Describe your private mortgage needs?* This field is required.

I want to get a second mortgage on top of a reverse mortgage

I want to get a second mortgage on top an existing mortgage/HELOC

I want to refinance an existing second mortgage

24

Mortgage amount required?* This field is required.

25

When are the funds required?* This field is required.

Less than 30 days

30-45 days

45-120 days

Unsure

26

Mortgage amount required?* This field is required.

27

What is the primary goal of getting an equity mortgage* This field is required.Select all that apply

Renovations

Debt consolidation

Pay off CRA

Divorce/separation

Investment

I want to buy another property

I want to access my equity for other reasons

28

When are the funds required?* This field is required.

Less than 30 days

30-45 days

45-120 days

Unsure

29

Are you looking to:

Buy a vacation home

Buy an investment property

Refinance an existing U.S. property

30

What kind of financing are you looking for?* This field is required.

A US mortgage on the US property

Equity take-out from my Canadian home (to use toward the US purchase)

A combination of both

Not sure — want to discuss options

31

Which U.S. state is the property located in (or intended)?* This field is required.

32

What is your estimated budget or property value?* This field is required.

33

Do you already own property in the U.S.?* This field is required.

YESNO

34

Are you a Canadian citizen or dual citizen?* This field is required.

YESNO

35

What areas would you like more clarity on? (Select all that apply)

Reverse Mortgage 101

Understanding documents

General Mortgages 101

Credit repair guidance

36

Are you planning to purchase or refinance in the next 12 months?

YESNO

37

Tell us more about the type of support your looking for

38

Would you prefer:Select all that apply

One-on-one coaching

Online resources

A group workshop

39

Which country are you considering retiring to?* This field is required.Select which country you are most likely considering retiring to

40

Do you plan to own or rent in your place of retirement* This field is required.

Rent

I'm unsure

Own

41

Will you need to finance a property purchase abroad? * This field is required.

YESNO

42

Are you also exploring residency or citizenship options? * This field is required.

YESNO

43

Do you plan to keep your Canadian property?* This field is required.

YESNO

44

Property status* This field is required.

Primary residence

Second home/cottage

Rental property

46

What is the estimated property value?* This field is required.

47

Do you have an existing mortgage or home equity line of credit (HELOC) on your property?

YESNO

48

What is your remaining mortgage balance?* This field is required.

49

Who is your current mortgage lender?* This field is required.

50

What is your current employment situation* This field is required.

Employed - Full-Time

Self-Employed

Employed - Part-Time

Unemployed

Retired

51

What is your credit score?* This field is required.

300 - 559 (Poor)

725 - 759 (Very Good)

560 - 659 (Fair)

760+ - Excellent

660 - 724 (Good)

I'm unsure what my credit score is

52

LTVHidden calculation of loan-to-value (remaining balance ÷ estimated property value).

53

Heads up — based on the property value and balance you entered, your loan-to-value is sitting above 80%. That can make this specific product harder to place on its own. But don't count yourself out. There's usually still a path forward when we look at the whole picture together. Let's talk it through on the call.

54

When is the best time for a call?🤙* This field is required.We'll send you a confirmation and reminder📆

55

When is the best time for a call?🤙* This field is required.We'll send you a confirmation and reminder🗓️

56

Let's Go!* This field is required.We look forward to speaking with you about your mortgage needs!

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