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Community Mortgage Services Corp.
License # 10906

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By filling out this application, you will supply necessary information in order to determine the financial solution that will work best for your needs.

Reason for Application

Refinance Purchase Renewal Other (please specify)

Primary Borrower

Applicant’s Name:
Applicant’s Date of Birth:
Applicant’s Social Insurance Number:
Current Street Address:
Town/City:		Postal Code:
Number of Years at Residence:
Employer’s Name:
Employer’s Address:
Current Position:
Years at Job:		Current Salary:
Home Phone #:
Cell/Mobile #:
Work Phone#:
Email Address:

Co-Applicant Information

Co-Applicant’s Name:
Co-Applicant’s Date of Birth:
Co-Applicant’s Social Insurance Number:
Current Street Address:
Town/City:		Postal Code:
Number of Years at Residence:
Employer’s Name:
Employer’s Address:
Current Position:
Years at Job:		Current Salary:
Home Phone #:
Cell/Mobile #:
Work Phone#:
Email Address:

Property to be Mortgaged (Please Complete if Address is Different from Above)

Current Street Address:
Town/City:		Postal Code:
Number of Years at Residence:

Property Description

Annual Property Taxes		In Arrears	Y ⁭ N ⁭
Original Purchase Amount:		Year of Purchase:
Approximate Size of Lot:	(for example 40 X 100)
Choose A property Description:	Detached Semi-Detached Duplex Triplex Condominium Other (describe)
Age of Building/Property:		Approximate Square Footage of Home:
Exterior Construction	(for example. Brick, Vinyl, Wood etc)
Rental Income from Property:
Number of Storeys:	(for example Bungalo, Two Storey etc)
Type of Heating:
Garage Type:	Single Car Double Car Triple Car Attached/Detatched
Estimated Value of Home

Personal Assets/Personal Liabilities

1^st Mortgage Holder	1^st Mortgage Amount	Monthly Payment
2^nd Mortgage Holder	2^nd Mortgage Amount	Second Payment:
Lien Holder:	Lien Amount:
Total Credit Card Debt	Total Loan Debt
Requested Loan Amount:

I/We agree that any mis-statement of fact herein shall entitle you to cancel the loan and to require immediate repayment of all moneys secured by the mortgage. The applicant hereby irrevocably authorizes the company to obtain all forms of personal and/or credit information.

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