Preliminary Loan Application

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

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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