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Mortgage Renewal

Please complete this application. Once you submit the application, we will contact you within 24 hours.

PRIVACY PROTECTION:
We take confidentiality very seriously! Your info will NOT be given out or used for promotional purposes other than to secure the service required.

Applicant Information

First name
 MI
 Last name
Date of birth
Referred by:
 Marital status
 Dependents
Current street address
 City
 Prov. State

 Postal code
 Years there
Previous address (if < 3 yrs at current address)
 City
 Prov.

 Years there
E-mail address
 Home phone
--		 Residential status
Current employer
 Current occupation
Work phone
-- x
Type of income
Current employer address
 Gross yearly income
$
Years there
Home type
 Stories
 Approximate square footage
 Approximate age
Number of units
 Garage
 Garage

Co-Applicant Information

First name
 MI
 Last name
Date of birth
 S.I.N.
 Relation to co-applicant
Current employer
 Current occupation
Phone number
-- x
Type of income
Current employer address (please leave blank if you do not know)
 Gross yearly income
$
Years there

Your Existing Mortgage

Details of First Mortgage (Complete this section only if you have an existing mortgage)
Mortgage held with (bank name)
$		 Balance
 Rate %
$		 Payment
 Schedule

 Maturity date
Property address
Details of Second Mortgage (This could also be a first mortgage on a 2nd property)
Mortgage held with (bank name)
$		 Balance
 Rate %
$		 Payment
 Schedule

 Maturity date
Property address

Desired Mortgage

Purchase price $
 Desired term
Amortization
Mortgage amount needed $  Yearly property taxes (Approximate) $
Desired Bank  Purchase Date (Approximate) 
Type of Mortgage

Group Information

Select the group or charity that we can make a contribution to on your behalf).
Comments (Please provide any additional information which could help us with your request)

APPLICATION AGREEMENT

By selecting the "I Agree" box below, I/We (hereinafter collectively "I", "my", "me", etc.) hereby authorize Buyingblock.com (hereinafter "the Broker") to arrange on my behalf the loan described above (hereinafter the "Loan"). I certify that the above information, which is furnished with the intent that it be relied upon by the Broker to arrange the Loan, is true and correct.

In Connection with my application for the Loan, I acknowledge that you may obtain and rely on a consumer report containing personal information about me, and I consent thereto and to the disclosure of such information to other credit grantors or consumer reporting agencies, and to the Broker's retention of this application for the Broker's records.

I agree