Our short application is an easy and fast way to request a mortgage. Please provide the following information.

Personal Information

*First Name  :
Preferred Name  :
*Last Name  :
Email  :
Referral Name  :
*Home Phone  :
Cell Phone  :
Work Phone  :
Marital Status  :
Are you a U.S. citizen?
Date of Birth  :
*Social Security or Tax ID #  :
Number of Dependents   :
Dependent Age(s)  :
Separate ages by commas.
Loan Officer  :
*Please Select Your Nearest Location :

Current Address

Street Address  :
City  :
State  :
Zip  :
Years at this Address  :
Rent or Own  :

Loan Details

Purpose of Loan  :
Property Usage  :
Property State  :
Loan Amount  :
Purchase Price  :

Monthly Income

Submitting income from alimony, child support, or separate maintenance income is optional if you do not want to use that income for qualification purposes.
Base Income  :
Bonuses  :
Commission  :
Other Income  :


Checking  :
Savings  :
Retirement Funds  :
Mutual Funds  :
Other  :

Employment Information

Self Employed :
No   Yes
Employer :
Address :
City :
State :
Zip :
Position :
Business Phone :
Years on Job :
Years in Line of Work :

Information for Government Monitoring Purposes

The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.
Option  :
I do not wish to furnish this information
Sex  :
Ethnicity  :
Hispanic or Latino
Not Hispanic or Latino
Race  :
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Information not provided
Not applicable

Policy Agreements

Privacy Policy :

We take our clients' financial privacy very seriously. During the course of processing your application, we accumulate non-public personal financial information from you and from other sources about your income, your assets, and your credit history in order to allow a lender to make an informed decision about granting you credit. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

We collect non public information about you from the following sources: (i) information we receive from you on applications or other forms; (ii) information about your transactions with us, our affiliates, or others; and (iii) information we receive from a consumer reporting agency.

We do not disclose any non public information about our customers or former customers to any third party, except as permitted by law.

Credit Authorization :

During your mortgage loan application process, ALCOVA Mortgage, LLC will perform a Credit Check to obtain and/or confirm information regarding your personal and financial background.

1. Areas reviewed under this Credit Check may include, but not be limited to, current and former employment, current deposit or investment accounts, current and past consumer credit accounts, and your mortgage/rental history.

2. Information received may be shared with necessary third parties, or any agent thereof, which could include, depending on your loan type, governmental agencies such as HUD/FHA/VA in connection with the consideration or administration of your mortgage loan.

3. A photographic copy of this authorization bearing a photographic copy of the signature(s) of the undersigned may be deemed equivalent to the original and may be used as a duplicate original.By affirming below, you authorize ALCOVA Mortgage, LLC to receive and, as needed, provide such information from any consumer reporting agency, creditor, financial institution, or other entity as may be needed to verify your credit information.

I accept the terms of the Policy Agreements and authorize ALCOVA Mortgage to perform a credit check


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