Lake Region Mortgage - Loan Inquiry

Lake Region
Mortgage Corporation
Your Neighborhood Lender . . . .

For residential mortgages, purchases, refinances and home equity loans.

call us at 320-231-1309 or 800-422-7339
Email: loans@lakeregionmortgage.com
Website:www.lakeregionmortgage.com

Lake Region Mortgage - Loan Inquiry Form

Please fill out the information below and click on the submit button when you are finished. If you do not have the information to complete a particular section of this application you may leave it blank.

If you prefer, you may print this application and mail or fax it to us. This information is confidential and will be used only by Lake Region Mortgage Corporation for the purpose of evaluating loan and mortgage options. This information will not be shared with other vendors or organizations.

Type of Mortgage and Terms of Loan
Property value	$
Loan Amount	$
No. of Years
Loan Type
Interest Rate Expected	%

Property Information And Purpose Of Loan
Subject property address
City, State, Zip
Year Built
No. of Units
Purpose of Loan
Type of Property
Source of funds and amount of funds available for downpayment / closing costs

Borrower Information
	Borrower	Co-borrower
Full Name
Social Security Number
Home Phone (incl. area code)
Business Phone (incl. area code)
E-mail address
Cell Phone Number
Best Time to be reached
Date of Birth

Present Address: Street
City, State, Zip

Rent or Own?

No. of years

Employer Information
Current Employer Street Address City, State, Zip
Position/Title/Type of Business
Business Phone
Date started
Gross Monthly Income	$	$

Additional comments or questions

Lake Region Mortgage Corporation
1601 East Highway 12
Willmar, MN 56201
Local 320-231-1309
Toll Free 800-422-7339
Fax 320-231-2416