Reverse Mortgage Proposal Request
Full Legal Name of Borrower
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Mobile
Please enter a valid phone number.
Format: (000) 000-0000.
Is there a spouse who will not be on the loan?
I have a spouse who will NOT be on the loan
I have a spouse who WILL BE on the loan
I do not have a spouse
Is there another borrower?
Yes
No
Full Legal Name of Co-Borrower or Non-Borrowing Spouse
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Property Information
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Estimated Value of Property
Is the Property Owned Free and Clear?
Yes, it is paid off
No, it is still being paid off
Homeowners Insurance (Monthly)
HOA Amount (Monthly)
Reason
This is where you explain why you want to get a reverse mortgage.
Tell us the story
Do I have permission to pull your credit report?
Yes
No
Credit Permission
I/We authorize Custom Rate PLLC to obtain a tri-merged consumer credit report. I/We understand that Custom Rate PLLC intends to use the credit report for the purposes of confirming my/our residency address, and verifying other credit information. I/We understand that in conjunction with the tri-merged credit report that Custom Rate PLLC may ask me/us to verify past and present employment earnings records, bank accounts, stockholdings, and any other asset balances that are needed to process the mortgage loan application. I/We understand that the credit report obtained is to be used solely in the processing of the mortgage loan application and that this information may only be shared with other agencies that have a direct connection with the processing of the mortgage loan application. I/We understand that credit inquiries have the potential to impact my/our credit score. I/We understand that this tri-merged credit report will be retained on file by Custom Rate PLLC along with all other loan application documents.
Borrower Signature
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this company is the Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney Street, Suite 3710, Houston, Texas 77010
Co-Borrower/Non-Borrowing Spouse Signature
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this company is the Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney Street, Suite 3710, Houston, Texas 77010
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