Oak Leaf Mortgage Inc.
118 East High Street - Mount Vernon, Ohio -43050
740.393.1888 phone   -   740.393.1998 fax
Loan Application
Home Loan Application Request Form

On this form we'll collect some basic information to get the ball rolling.  Please fill out and submit the form, and we'll contact you right away to get the private information that we need to move forward.  We look forward to exceeding your expectations!
Applicant Information
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Co-Applicant Information
First Name:
Last Name:
Contact Information
Daytime Phone:
Evening Phone:
Email:
Financial Information
Loan Type:
Loan Amount: (USD)
Property Information
Property Type:
Occupancy:
Purchase Price: (USD)
Appraised Value: (USD)
Mortgage Balance: (USD if applicable)
Other Information
Comments:
I authorize Oak Leaf Mortgage to verify
my credit and employment history.

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