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Apply for a Loan By FAX

Please complete the form below and press the "browser's print icon" or "Ctrl+P" to get a print. Fax the printed form to:

Manzel Mortgage at 617-436-4855
Attention: New Loan Application Dept.


Licensed in:
Colorado, Connecticut, Florida, Maine, Massachusetts, New Hampshire, & Vermont


We do not share or sell your information to anybody.


Fields marked with an asterisk(*) are required. Others are optional.

First Name:
 *
Last Name:
 *
Street Address:
 *
City:
 *
State:
 *
Zip Code:
 *
Phone, day (xxx-xxx-xxxx):
 *
Phone, evening (xxx-xxx-xxxx):
 *
How long at Current Address (Years):
 *
Date of Birth (MM/DD/Year):
 *
Social Security No. (xxx-xx-xxxx):
 *
Gross Monthy Income ($):
 *
Name of Employer:
 *
Employer Phone No. (xxx-xxx-xxxx):
 *
Position:
 *
How long at Current Job (Years):
 *
Have you ever filed for Bankruptcy:
 *
Estimated Total Credit Card Debt ($):
 *
Other Monthly Debt (car loan, school loan, etc):
*
Property Type:
*
Estimated Property Value ($):
 *
Requested Loan Amount ($):
 *
Requested Loan Term (Years):
 *
Loan Type:
*
-- Refinance Information --
For second mortgage holder enter the data as shown below in the commnets box
Loan Amount ($):
  
First Mortgage holder Company:
  
Monthly Payment ($):
  
Are Taxes & Insurance Included:
  
Current Rate (%):
  
Current Mortgage Term (Years):
  
-- Co-Borrower Information --
Co-Borrower Name (i.e., John Doe):
  
Date of Birth (MM/DD/Year):
  
Social Security No. (xxx-xx-xxxx):
  
Gross Monthy Income ($):
  
Employer:
  
-- Property Location --
City:
*
State:
*
Zip:
 *

Comments:


Please call 800-335-5521 to speak to a representative.

Terms & Agreements: Married applicants may apply for a separate account. All statements are true and correct and are made for the purpose of obtaining a loan. Authorization is given to Manzel Mortgage to obtain my credit report. Verification or re-verification of any information contained in this form may be made at any time by Manzel Mortgage, its agents or affiliates either directly or through a credit reporting agency or other third party.

 

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