Reverse Application Questionnaire

Application Questionnaire

Have you completed the Quote Proposal Request form?

Yes

Counseling Certificate file should be of one of these types: jpg, jpeg, gif, png or pdf

Broker Information

Broker Name

Borrower Information

Borrower First Name

Borrower Last Name

Borrower Phone Number

Citizenship

US Citizen

Lawful Perm. Resident Alien

Ethnicity

Race

Alternative Contact's Information

First Name

Last Name

Phone Number

Street Address

City

State

Zip

Relationship to Borrower

Co-Borrower Information

Is there a Co-Borrower?

Yes

Non-Borrowing Spouse Information

Is there a Non-Borrowing Spouse?

Yes

Subject Property Information

Year Built

Years of Residence

1st Mortgage Balance

2nd Mortgage Balance

Other Liens

Living Trust

Yes

Power of Attorney?

Yes

Loan Information

Amortization Type

Rate/Margin %

HECM Type

Loan Originator Information

First Name

Last Name

Additional Information

If you are experiencing issues submitting the proposal request above, please complete the pdf Application Request Form and submit via email to ReverseProcessing@LHFS.com.