Paramount Capital

Please complete the following application as completely as possible. We will have one of our representatives contact you as soon as possible.

FIRST APPLICANT:

First Name:

Middle Initial:

Last Name:

Social Security #:

Birthday (mm/dd/yy):

Application Type:

Marriage Status:

Phone:

Email Address:

Housing Information

Present Address:

(Number, Street, Apt. P.O. Box)

City:

County:

State:

Zip:

How Long?

years months

Previous Address:
(If less than 5 years)

(Number, Street, Apt. P.O. Box)

City:

County:

State:

Zip:

How Long?

years months

Employment Information

Employer:

How Long?

years months

Employer Phone:

Position:

Gross Monthly Income:

Previous Employer:
(If less than 2 years @ current)

How Long?

years months

Employer Phone:

Position:

Gross Monthly Income:

Additional Income Source:

Gross Additional Income:
(monthly)

The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. 'You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate on this information , or on whether you choose to furnish it. However, if you choose not to furnish this information, under federal regulations,, the lender is required to note ethnicity and sex on the basis of visual observation or surname. If you do not which to furnish this information please select that option.

Ethnicity

Race or National Origin:

Sex:

SECOND APPLICANT:

First Name:

Middle Initial:

Last Name:

Social Security #:

Birthday (mm/dd/yy):

Daytime Phone:

Email Address:

Second Applicant Employment Information

Employer:

How Long?

years months

Employer Phone:

Position:

Gross Monthly Income:

Previous Employer:
(If less than 2 years @ current)

How Long?

years months

Employer Phone:

Position:

Gross Monthly Income:

Additional Income Source:

Gross Additional Income:
(monthly)

Ethnicity

Race or National Origin:

Sex:

GENERAL:

Current Home Value:

Purchase Date
(ex. mm/dd/yy):

Purchase Price:

First Lender:

Balance:

Monthly Payment:

Second Lender (if any):

Second Balance:

Second Monthly Payment:

Last Appraisal Amount:

Last Refinance Date:
(if applicable)

County:

Other Creditor:

Type:

Monthly Payment:

Balance:

WE ARE REQUESTING FUNDS FOR: (select one)


	Swimming Pool		Debt Consolidation
	Other Home Improvements		Cash Out

Pool Builder Name:

Contract Price:

Down Payment:

Amount Requested:

Term:

months

Defer Payment:

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