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Fill out the application below to get approved for your purchase, refinance, home equity, home improvement or debt consolidation loan. *Are you a homeowner ?  Yes, No  Applicant Information Amount Requested* Purpose of Loan Fast Cash Debt Consolidation Home Improvement Lower Interest Rate Change Terms of Current Loan Home Purchase Construction Commercial Other    Applicant  Co-Applicant First Name* First Name* Last Name* Age Last Name* Social Security Number:* - - Social Security Number: - - Home phone Home phone Work phone Work phone  Property Information Owner Occupied,  Investment Property  Subject Address  Street  State * We serve State of California Only CA AL AK AZ AR CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY City  Zip Code  Names on Deed  .Yearly Taxes ($)  Ins. ($)   Refinancing Orig. Purchase Date Orig. Purchase Price ($) Present Market Value ($) 1st Mortgage Balance ($) 2nd Mortgage Balance ($) 1st Mortgage Holder Interest Rate (%) 2nd Mortgage Holder Interest Rate (%) Current Payment ($) Years  Remaining:  Current Payment ($) Years  Remaining:  Include Taxes and insurance ? Yes No Include Taxes and insurance ? Yes No  Purchases Have you found the  particular home you want to purchase ? Yes No Purchase Price: ($) Down payment: ($) Source of Funds: Savings 401K/IRA Stocks Gift MIX Proposed Closing Date: Seller Concession: (%)  Employment  Employer  Employer Name: Name: Phone: Phone Income ($): Income ($): Self Employed ?   Self Employed ? Position: Years:    Position: Years:    Additional Income ($): Additional Income ($):  Other Comments: E-Mail: * Best time to call How did you find our site? Search Engine Browsing Link Friend Newspaper Radio Television Billboard Mobile Ad Other   I/We hereby give our consent to Premiere Financial Services, and any credit reporting bureau designated by Premiere Financial, to obtain any and all information concerning our employment, checking and/or savings account, obligations and all other credit matters which they may require in connection with our application for a mortgage loan. This form may be reproduced or photocopied and a copy shall be as effective consent as the original which we have submitted.