Preliminary Loan Application

The information provided on this form will be held in strict confidence
in compliance with the Financial Privacy Act.

Please fill in the information requested. Then click "SEND" to submit your application. A printer-friendly copy of this form can be printed and faxed to us at (706) 860-4205.

Click here for an Adobe Acrobat copy of this form to fill in online, print and fax.

To save a blank application to your computer, right-click here, and choose "Save Target As" from the shortcut menu.

If you have any questions or comments, please feel free to call us locally at (706) 860-4200 or on our toll-free number 1-800-860-4714. We will contact you with answers to your questions.

Thank you for giving Augusta Mortgage this opportunity to be of service.


Personal Information Borrower Co-Borrower
First name
Middle initial
Last name
Social security number
Date of birth ex: 12/03/56 ex: 12/03/56
Home phone - -
Cell phone - -
Email address
Current street address
City
State
Zip Code
How long at this address years months years months
Do you currently Own   Rent Own   Rent
If at current address less than 2 years, give former address and number of years there.
Former street address
Former City
Former State
Former Zip Code
Did you formerly Own   Rent Own   Rent
Number of years at former address

Current Monthly Housing Expense    
(Excluding utilities)

Employment Information  
Self Employed Yes   No Yes   No
Employer Name
Street Address
Suite/Building
City
State
Zip Code
Position/Title
Annual Salary
Business Phone - ext. - ext.
Date of hire ex. 03/05/02 ex. 03/05/02

Current Credit Obligations  
Borrower Co-Borrower
1. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance
2. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance
3. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance
4. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance
5. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance
6. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance
7. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance
8. Creditor Name
     Monthly Payment Balance   Monthly Payment Balance

Alimony and/or Child Support Obligations Alimony and/or Child Support Obligations

How did you hear about Augusta Mortgage?  
Additional Comments or Explanations  
 

 
By checking this box, you acknowledge that you have read and agreed to the following statements:
  1. I understand that I need to click on the button below to order for Augusta Mortgage Company to evaluate this application.
  2. I authorize Augusta Mortgage Company to access personal credit data for me in conjunction with this credit prequalification application.
  3. Avantus or Merchants Credit bureaus, Augusta Mortgage Company’s service provider is authorized to charge the card listed above in the amount of $24.00 for credit reporting fees related to this prequalification. I understand this charge is non-refundable.
  4. I request that Augusta Mortgage Company’s credit vendor , Advantus or Merchants Credit Bureau, provide me with a copy of my credit report pursuant to section 609 of the Fair Credit Reporting Act (FCRA).