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ONLINE MORTGAGE APPLICATION

Please complete our on-line form to the best of your
ability. Only name and contact info is required. You will
be contacted by an Allstate Mortgage Representative.

If you prefer to give this information over the phone,
or if you have any questions, please call us in Ocala:
352-351-0200 or toll-free 800-351-0200.

CO-BORROWER
General Information

Loan Purpose:

Purchase Refinance Line of Credit Construction 2nd Mortgage Other

Type of Loan requested: Loan Amount: Term Requested (Number of years 5-30):


Contact/Co-Borrower('s) Personal Information
Name (First, Middle, Last, Suffix): Home Telephone Number:
Complete E-mail Address: Work Telephone Number:
Rent Or Own?:

Social Security Number:
Current Residence Address: Date of Birth:
City, State, Zip Code: Marital Status:
Time at Current Residence:    

Employment / Income Information
Self-Employed: Employer Phone:
Name of Present Employer: Time on this job (Years/Months):
Address of Present Employer: Current Position or Title:  
City, State, Zip Code: Gross Monthly Income:  
Other Income
Only necessary if you want it to be considered for this loan
Other Income Total
Source:
Choose all that apply
Social Security Pension Child Support Rental Other

Liquid Assets
Total Amount   
Source:
Choose all that apply
Checking Savings 401K CD Investment/Other
How do you wish to be contacted?
Home Phone   Work Phone   E-mail   Regular Mail  

  

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