Reverse Mortgage Quote Proposal Request

To pre-review your borrower’s credit and income situation please complete the following form. The requirement of pre-counseling approval is intended to prevent unnecessary counseling and appraisal expenses. Please note that pre-counseling approval is NOT loan approval nor a commitment to lend. Pre-counseling approval is based solely on the information provided and should be used as a tool to communicate with your borrower. Land Home Financial Services can not make a final decision until completing a full review of the complete file.

Broker Information

Loan Originator

Property Information

Borrower Information


Non-Borrowing Spouse Information

Payment History

Additional Information