Short Loan Application - Nicolas Mortgage

Please provide all of the requested information. When you have completed the form, press the submit button to send your application. We will then contact you for pre-qualification and assist you with the process of obtaining a loan.

Borrower Information

First Name

Middle Name

Last Name

Email Address

Social Security Number

Date of Birth

Street Address

City

State

Zip

Home Phone

Business Phone

Mobile/Pager/Alternate

Fax

Contact Me at

Best Time to Call

Total Gross Yearly Income (Income Before Taxes)*

*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co- Borrower(C) does not choose to have it considered for repaying this loan.

Total Monthly Debt Payments (including Alimony & Child Support)

Co-Borrower Information

Will there be a co-borrower on this loan?

Yes No

Referral Information

Referred by

Loan Information

Loan Purpose

Property Type

Purchase Price

Amt Avail for Down Payment or Closing Costs

Credit Check Authorization

Do you authorize us to pull you and your co-borrower’s credit reports in order to pre-qualify you for a loan? (If so, please provide social security numbers and date of births).

Yes No

Special Instruction/Comments:

By submitting, you agree to our Terms and Privacy Policy and all info entered was done accurately & truthfully.