Roy Tegtow - L&G Mortgage

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Loan Application Short Form

Please supply the following information. Roy Tegtow will contact you to continue the process.

(Fields marked with * are required)

First Name: *
Middle Initial:
Last Name: *
Address:
City:
State:
Zip Code:
Email Address:
Home Phone:
Work Phone:
Cell Phone:
Best Contact: *
Approximate Credit Score:
Co-Borrower?

Co-Borrower Info:

First Name: *
Middle Initial:
Last Name: *
Different address from primary borrower?
Address:
City:
State:
Zip Code:
Email Address:
Home Phone:
Work Phone:
Cell Phone:
Best Contact: *
Approximate Credit Score:

Loan Purpose:
Occupancy:
Loan Amount: $
Purchase Price / Present Value: $
Property Address:
City:
State:
Zip:
Estimated Closing Date:
Questions / Comments:
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