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Mortgage Inquiry

Please enter information on the form below and then click "Next" when completed. Please note: if any input errors are detected or information is missing you will need to correct the fields reflected in red font.

Referring Employee
Referring Branch:
Referring Employee:
The Customer is being referred to which Mortgage Consultant?
Referring Employee Action:
Inquiry Received By Phone In Person
Customer Contact Information
Prefix:
City:
State:
Zip Code:
Home Telephone:
Work Telephone:
ext.
Alternate Telephone:
Is there a best time to call? AM PM Any Time
Can we call in the evening? Yes No
If yes, at which phone# Home Phone Work Phone Alternate Phone
Can we call in the weekend? Yes No
If yes, at which phone# Home Phone Work Phone Alternate Phone
Is customer an ESB depositor? Yes No
Transaction Summary
Property Type:
ResidentialCommercial
Loan Request
Purchase
Has contract been signed? Yes No
Purchase Price:
Refinance
Current Lender:
Current Loan Balance:
Date Loan Taken Out:
Is this an ESB Mortgage? Yes No
Emigrant Loan Number:
Is there a second mortgage? Yes No
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