BORROWER
General Information

If you are currently working with an Omega Loan Officer,
please tell us who and which office is assisting you:

Officer Name:
Office:

Borrower Name:
 SS#
Phone: (Work)
 Phone: (Home)
E-mail:
 Date of Birth:
Marital Status:
Address Information  (past 2 years history needed)
Current Address:    Years at Current Address: 


Previous Address:

Previous Address:

Asset Information
Do you Rent or Own your current address? 
Do you own other property? 
Do you have other assets? 
      Checking/Savings:
      Retirement:
Income Information  (past 2 years history needed)
Self-Employed? Yes/No 
Name Of Employer 
Years There 
Annual Salary 
Previous Employer 
Years There 
Previous Employer 
Years There 
Other Income? 
Notice: Alimony, Child Support or separate maintenance income
need not be revealed if the Borrower (B) or Co-Borrower (C) does not
choose to have it considered for repaying this loan.
Amount of Other Income 
Do you pay Child support? Annual Amount: 
Do you pay Alimony? Annual Amount: 
CO-BORROWER
General Information
Co-Borrower Name:
 SS#
Co-Borrower Phone: (Work)
E-mail:
 Date of Birth:
Marital Status:  
Address Information  (past 2 years history needed)
Current Address:   Years at Current Address: 


Previous Address:

Previous Address:

Asset Information
Do you Rent or Own your current address? 
Do you own other property? 
Do you have other assets? 
      Checking/Savings:
      Retirement:
Income Information  (past 2 years history needed)
Self-Employed? Yes/No 
Name Of Employer 
Years There 
Annual Salary 
Previous Employer 
Years There 
Previous Employer 
Years There 
Other Income? 
Notice: Alimony, Child Support or separate maintenance income
need not be revealed if the Borrower (B) or Co-Borrower (C) does not
choose to have it considered for repaying this loan.
Amount of Other Income 
Do you pay Child support? Annual Amount: 
Do you pay Alimony? Annual Amount: 
Property Information
Are you planning on purchasing or refinancing a home?
If you are planning on purchasing:
What Type Of Property Are You Seeking?
Single
Condo
Multi   # of Units
Subject Property Address:   or (don't have one yet)



What is the loan amount you are seeking? 
What is your home price range? 
If this is a refinance please provide the following information:
Current Loan Amount: 
Current Interest Rate: 
Annual Taxes: 
Annual Insurance Cost: 
Is the current mortgage fixed or variable? 
Estimated Property Value? 
How did you hear about us? Other-
If you have given us your social security number may we start your loan
process by looking at your credit? Yes/No


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Omega Mortgage:
Hudson MASS Lender Lic #MC2398
Leominster MASS Lender Lic #MC1261
Billerica MASS Lender Lic #MC2517
Everett MASS Lender Lic #MC2465
Sudbury MASS Lender Lic #MC0077
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Connecticut Lender Lic #12726
Florida Lender Lic #ML0400201
Michigan (DBA Omega Financial) Lender Lic #FL3323
New Hampshire Lic# 5920MB Lic #9862-MHL
Licensed by the New Hampshire Banking Department
Tennessee Lic # 0000003251
Georgia Lic# 21500