Online Purchase and Refinance Application
Applicant Info:
These basic pieces of information will allow us to contact you to continue the application process. An email will be sent to the address you provide containing important contact information.
Start here:
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I am interested in:
Purchasing
Refinancing
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Have you spoken with a Loan Specialist or been referred to a Home Loan Specialist
Yes
No
If yes, with whom?
Select One
Paul G. Pistey
Charles La Flair
Raul De La Vega
Geovanny Angeles
Steven Tavera
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Your First Name:
First Name is required
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Your Last Name:
Last Name is required
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Email:
Email is required
Invalid email format.
Date of Birth:
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Day Phone:
*
*
Phone is required
Cell Phone:
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Mailing Address:
Address is required
Address 2:
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City:
City is required
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State:
Select a State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
State is required
*
Zip:
Zip is required
Years at present address:
(Round to nearest whole year. Use "1" for 0-11 months)
Employment Info:
Employment data is key information for qualifying for a loan. Please use this area to tell us about your current work status.
Self Employed?
Yes
No
Company or Employer Name:
Years at Current Job:
Years in Line of Work:
Annual Base Income:
Avg Bonus/Commission:
Loan Info:
Understanding your goals and/or progress with a home loan lets us know how to guide you best to the next step and to a successful close. Use this area to tell us about your loan.
Estimated Purchase Price:
State where purchase will be made:
Not Relocating
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Amount available for down payment:
Do you currently have a contract on a home?
Yes
No
Do you currently own a home?:
Yes
No
Selling or Renting?:
Selling
Renting
Are you working with an experienced Realtor you trust?
Yes
No
Not Sure
Not sure:
Is this Realtor one of Dave Ramsey's ELP Realtors?
Yes
No
In order for our Loan Specialist to coordinate with your Realtor, please provide their contact information here:
Realtor's Name:
Realtor's Email:
Realtor's Phone:
(use format: 888-888-8888)
Any additional info:
Goals of Refinance:
Lower Rate
Different Term
Cash Out
Other
Current Interest Rate:
Rate
Term
(in years)
Fixed
Adjustable
State where refinance will occur:
Not Relocating
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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Value of your home:
Home Value
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Balance Owed on 1
st
Mortgage Only:
see below for 2
nd
or HELOCs owed
Home Balance
Years left on mortgage:
Are you paying mortgage insurance?:
Yes
No
Any additional info:
(2nd mortgage balance,
other home equity balances,
or other helpful information)
Co-Applicant Info:
(optional)
This area provides us with information about an additional person on the loan. Only the applicant will receive a confirmation email. If applicable, please provide information about the co-applicant.
Co Applicant First Name:
Co Applicant Last Name:
Co Applicant Date of Birth:
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Feb
Mar
Apr
May
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Jul
Aug
Sep
Oct
Nov
Dec
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2
3
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5
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20
21
22
23
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25
26
27
28
29
30
31
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
Co Applicant Self-Employed?:
Yes
No
Employer/Business Name:
Years at Current Job:
Years in Current Line of Work:
Annual Base Income:
Average Annual Bonus/Commission:
Mortgage Planning:
(optional)
At Churchill, good business is about making the customer aware of his or her options. We approach a loan with the heart of a teacher while providing great products for our customers. Use this space to tell us about your current and future financial goals and we will show you the most helpful methods to seeing them realized.
Financial Goals
What is most important about this mortgage to you?:
Please Select
Lowest Payment
Lowest Closing Cost
Maximize Tax Benefits
Improve Credit History
Eliminate Other Debt
Paying Loan Off ASAP
Other
Which personal goals are most important?:
Please Select
Building Net Worth
Moving To Larger Home
Mortgage Paid Off Early
Financial Freedom
Save Money For Kids College
Investing In Stock Market
Other
How long do you plan on living in the house?:
Please Select
Less Than 3 Years
3-5 Years
5-10Years
over 10 Years
How much is your current mortgage/rent payment?:
What mortgage payment do you feel comfortable making?:
Is your household budget currently working?:
Please Select
No
Yes
Do you have an emergency fund?:
Please Select
No
Yes
What is your preferred balance for that account?:
What is the current balance for that account?:
Do you expect any of the following in the next 5 years?
A new child?
Please Select
No
Yes
College expense?
Please Select
No
Yes
Change in work time?
Please Select
No
Yes
New or Replacement Vehicle
Please Select
No
Yes
Do you have a strategy to handle these expenses?
Please Select
No
Yes
Finished!
By submitting this form, I/we agree to your Privacy Policy Terms Of Use andauthorize Churchill Mortgage Corporation and/or their Preferred Provider for our area and/or The Churchill Agency to receive the above information to assist in obtaining a home loan. I/we also authorize Churchill Mortgage Corporation, The Churchill Agency and/or their Preferred Provider for our area to obtain a credit report from a credit reporting agency, and to contact us regarding but not limited to mortgage and insurance services and products via telephone, mobile phone (including through automated dialing), and/or email, even if telephone numbers or email I provide are on any Do Not Call/Contact registry, such as corporate, state, or the National Do Not Call Registry. The submission of this form does not constitute in any way a formal loan application or a commitment for a loan.
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Applicant Full Name:
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| COPYRIGHT 2011. All rights reserved.
Leading Mortgage Solutions
11622 El Camino Real Ste.
100 San Diego CA 92130
Paul pistey - Branch Manager
CA DRE lic # 01335264
(619) 549-9044
1-855-825-6267