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Millenia Mortgage
91 Clinton Road (Suite 2D)
Fairfield, NJ 07004

Tel: 973.575.5557
Fax: 973.575.9323
Email Millenia

Short Application

Contact Information

Name:
Email:
Street:
City:
State:
Zip:
Home Phone:
Work Phone:

Finance Information

Property Location:
Loan Type:
Desired Amount:
Type of Loan:
Annual Household Income:
My credit history is:

First Mortgage Information

Current Interest Rate:
Fixed
Adjustable

Purchase

Fill out this section if this loan is for a purchase.
Estimated Property Value:
Down Payment Amount:


Refinancing

Fill out this section if you are refinancing a current loan.
Property Value:
1st Loan on Property:
2nd Loan on Property:
3rd Loan on Property:
Reason for refinancing:
If Other, specify:


Second Mortgage

Fill out this section if you are taking out a second mortgage, credit line, or home improvement loan.
Type of Loan:
If Other, specify:
1st Loan on Property:
2nd Loan on Property:
Reason for Loan:
If Other, specify:


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