Lender Intake Form Lender Intake Form Borrower(s) Name(Required)First NameMiddle NameLast NameDate of Birth Add RemoveProperty Address(Required) Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Borrower's Email Borrower's Phone NumberClosing Date(Required) MM slash DD slash YYYY Dwelling Usage(Required)PrimarySecondaryRental PropertyIs this loan a new purchase or refinance?(Required)New PurchaseRefinanceWill the Property Require Flood Insurance?(Required)YesNoLoan Type(Required)FHA/Other Government LoanConventionalVAOtherDo you have a copy of the elevation certificate?(Required)YesNoPlease note that an elevation certificate is needed for FHA and most government loansWill the Insurance be Escrowed(Required)YesNoWould you like us to send the quote directly to this client?(Required)YesNoEmail Address of Recipient(Required) Lending Partner Contact InformationNamePhoneEmail Add RemoveIf you have any documentation like an elevation certificate, quote comparison, etc, upload them here Drop files here or Select files Max. file size: 98 MB. If you have any other information to provide, please leave them here, thank you!