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All information submitted will remain completely confidential by Adirondack Home Mortgage, Inc. and will not be shared or sold to anyone or used for any purpose other then the pre-qualification of you to purchase a home. 

  

  

        

          










      

    

      So that we
        may serve you better, please complete ALL of the following information.

        		
    

    

      Borrower
        Information
    


    

      I am interested in:
      
        
    


    

      If refinancing:
      
    


    

      Current
        value of home: 
        

      
    


    

      Amount
        currently owed: 
        

      
    


  

    

      
        
Current
        interest rate:

  
    


    

      I am interested in a
      

        30 year


20 year


15 year		
    


    

      Name:
       
        
    

    

      Address :
       
        
    

    

      City:
       
        
    

    

      State: 
       
        
    

    

      Zip:
       
        
    

    

      Home Phone:
       
        
    

    

      Work Phone:
       
        
    

    

      Email: (IMPORTANT)
       
        
    

    

      Occupation:
        
        
    

    

      How Long Employed:
       
        
    

    

      Gross Income: 
               
        
        
    

    

      Monthly Debt: 

        (i.e. credit cards, student loans, car payment, etc, do not include rent
        or utilities)		
               
              
    

    

      Credit Standing:
      
        
    

    

      
        
Co-Borrower
        Information

      		
    

    

      Name:
       
        
    

    

      Occupation
        
        
    

    

      How Long Employed:
       
        
    

    

      Gross Income:
        
        
    

    

      Monthly Debt: 

        (i.e. credit cards, student loans, car payment, etc, do not include rent
        or utilities)		
               
    

    

       How did you hear about us?
        
        
    


    

      I was referred to:
      


 Janet Gioia



 Stanley Len



 Laura Christiana



 Gary Frederick



 Amy Gioia



 Annmarie Ruchel



 Jennifer Palleschi		
    


    

      Comments:
         


        
    

    

      
      

      

      
    

  

  


        

      

      
 

      

      

      
2004 Cardiff Road

      Schenectady, NY 12303 

      
Phone:  (518) 355-3737

      Fax:  (518) 355-5470

      
Email: info@adirondackhomemortgage.com

      
Registered Mortgage Broker -
      NYS Banking Department - Loans arranged with third party providers

      
 

      
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