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Mortgage Information Form
How I Heard About Citizens Trust Bank Mortgage?
*Please choose an option:    
If Other or Citizens Trust Bank Associate referral:     
Borrower
Name:     
Social Security #:     
Date of Birth:     
Home Phone:  
Work Phone:  
Cell Phone:  
E-mail:     
Current Home Address:  
City  
State:
Zip:  
Resident for how long at current address:   Years      Months
If less than 2 years, list previous address:  
Employer:     
How long at current job:      Years         Months
If less than 2 years, list previous employer(s):  
Purpose of inquiry: Purchase
  Refinance
I/We intend to apply for joint credit:
Date:


 
Co-Borrower
Relationship to borrower:  
Name:  
Social Security #:  
Date of Birth:  
Home Phone:  
Work Phone:  
Cell Phone:  
E-mail:  
Current Home Address:  
City  
State:
Zip:  
How long at current address:   Years      Months
If less than 2 years, list previous address:  
Employer:  
How long at current job:   Years      Months
If less than 2 years, list previous employer(s):  
Purpose of inquiry: Purchase
  Refinance
I/We intend to apply for joint credit:

By completing and signing this information Worksheet, I/We are authorizing Citizens Trust Bank to obtain a consumer credit report through the three credit reporting agencies to evaluate the financial readiness to address the mortgage loan request. I/We are authorizing Citizens Trust Bank to communicate with me/us/ by email, phone or US mail once a credit decision has been determined.

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