Mortgage Application

  Your New Mortgage is For ...
Pre-Approval Purchase Other Consolidate Debt Refinance Existing
When do you think you will need the mortgage?    

What is your top priority? Low Rates
Cash Back
Maximize Mortgage
Flexible Payments
Pay Mortgage Off Quickly
  Financial Institution ...
Which financial institution do you currently deal with?
  Tell Us About You...
First, Last Name:
Birth Date
Marital Status Dependents

Other Applicant's First, Last Name
Birth Date
Marital Status Dependents
  How Can Designer Mortgages Inc Contact You ?
Home Phone Work Phone Fax Email   **REQUIRED**
How do you prefer to be contacted ?    
Other Applicant
  Where Have You Lived ? ... (3 Year History)
Street Address, City, Province, Postal Code Years Tenure
Prior to that ...
  Tell Us About Your Work ...(3 Year History)
Employer, City, Position How Long Income/Year
Other Applicant
  What is Your Net Worth ? ...
  What is the annual gross income for
  you and your co applicant?

What Do You Currently Own ? What Do You Currently Owe ?
Description Value Description Balance Payment
Vehicle Type   Loans & Leases    
Life Insurance
Other Asset
Other Asset      
  Your Present Home & Mortgage ...
LandLord Monthly RENT    
or Mortgage Holder Monthly Payment Mtg Balance Home Value
Term : yrs & Matures: Taxes Condo Fees Utilities
  Your (New) Property Details ...
Address ... Enter existing if refinancing
Use Type Ownership  
Price Down Pmt Down Pmt Source  
Closing Date Mthly Taxes Mthly Condo Fees Mthly Utilities
  Do You Have any Further Comments or Notes ?
Your Authorization

The above information is submitted to enable VERICO Designer Mortgages Inc. to consider a mortgage loan, and is to the best of my /our knowledge and belief a true statement of my/our personal information. In submitting this information, I /We hereby consent to VERICO Designer Mortgages Inc. obtaining such credit reports and other information as VERICO Designer Mortgages Inc. may deem necessary at any time in connection with this application for a mortgage loan. I/We hereby consent to the disclosure of my/our personal and credit information to any credit reporting agency, financial institution, legal firm, title insurance company, mortgage insurance company. I /We also consent to receive periodic mortgage account information.

Your privacy is important. We are committed to respecting and protecting your privacy and security. We have implemented measures to protect the privacy & security of your personal information through strict policies and practices in compliance with applicable Federal and Provincial privacy legislation. Please contact us to discuss our privacy & security policies and practices.

Each VERICO Broker is an independent owner and operator

    By submitting your application you accept the above statements.

I/We have read the above Authorization statement.