By Completing the Loan Application below, you are consenting to correspondence via email, telephone and U.S. Post from Garfield Mortgage Corporation. Your information will not be provided to any other third parties and is strictly confidential.

Loan Information:

Property Address:                                                                  

Estimated Property Value:               Type of Property:                        

                  Single Family Condominium Multi-Family                      

Current Mortgage Information:

1st Mortgage Balance:                    1st Mortgage Payment:     

2nd Mortgage Balance:                   2nd Mortgage Payment:                   

Borrower Information:

Borrower Last Name:                     Borrower First Name:                      Borrower date of birth:

Home Phone:                                  Cell Phone:                                

Email Address:                                Please Contact Me Via:                 Best Time to Contact Me:          

                  Telephone Email U.S. Post                                        

_______________________________________________________________________________________________________

Co Borrower Last Name:                Co Borrower First Name:            Co Borrower date of birth:

Home Phone:                                  Cell Phone:                                

Email Address:                                Please Contact Me Via:               Best Time to Contact Me:           

                  Telephone Email U.S. Post                               

Additional Comments: