Reverse Mtg. Form

Is this a refinance of an existing reverse mortgage?
Is this loan being transferred from another reverse lender?
Credit Evaluaiton
Great Credit
A few collections and late's
Bankruptcy or NOD within 2 years
Poor Credit
Little to no credit
Unsure at this time
Full Address of Subject Property with Zip Code
County of Subject Property
Balance due on Mortgages 1st and 2nd
Market Value of Home
Type of Home :
Single Family Residence
Condo (FHA approved condos only)
2-4 Units
Planned Unit Development
Transaction: is this a purchase?
Do you plan to use Power of Attorney?
Is this loan Vested in a trust?
Borrower Married?
Borrower Full Name
Borrower Date of Birth
Co-Borrower Full Name
Co-Borrower Date of Birth
Total Monthly Household Income
Total Monthly Household Assets
Total Monthly Housing Expenses
Number of Household Members Living in Subject Property
Monthly Credit Debt