Reverse Mortgage Questionnaire

Reverse Mortgage Questionnaire - Form

Borrower Information

Borrower Name

Date of Birth

Age

Type

Preferred Phone Number

Type

Alternative Phone Number

By checking this box, I consent to receive SMS messages. I understand that Message and data rates may apply and that I may reply STOP to opt-out of future messaging; reply HELP for additional messaging help. Message frequency may vary depending on interactions between you and our agents. Carriers are not responsible for delayed or undelivered messages.

See our SMS Terms & Conditions & Privacy Policy here for more details.

Do you have a Co-borrower?

Yes

Co-Borrower Information

Co-Borrower Name

Date of Birth

Age

Type

Preferred Phone Number

Type

Alternative Phone Number

Property Information

Address

City

State

Zip Code

Owned Since

Repairs Needed (Select any that apply)

Other repairs

Property Expenses

1st Mortgage Company

2nd Mortgage Company

Monthly Payment

Other liens or mortgages

Monthly homeowners association

Monthly homeowners insurance

Have property taxes, HOI, and HOA been paid on time for the last 24 months?

Yes

Borrower Income

W-2 Employment

Yes

Hourly Rate

Hours per week?

hr/wk

Start Date

Social Security

Pension

Other Sources

Notes

Co-Borrower Income

W-2 Employment

Yes

Hourly Rate

Hours per week?

hr/wk

Start Date

Social Security

Pension

Other Sources

Notes

Borrower Assets

Checking

Stocks

Savings

Bonds

401K/IRA

Other

Co-Borrower Assets

Checking

Stocks

Savings

Bonds

401K/IRA

Other

Attorney/Estate Planning Information

Do you have a will?

Yes

Do you have a living trust?

Yes

Other/Notes

Other/Miscellaneous

Do you have children?

Yes

Should we schedule a call with them to discuss RMs?

Yes

Notes

Additional Information