Home Purchase Verification

Personal Information

Borrower Name(s):*

Address of Home Purchased

Date of Purchase

Daytime Phone Number

Email Address

Lender and Mortgage Information

Name of Lender*

Address of Lender

Purchase Price

Loan Closing Date*

Closing Costs*

Closing Costs Received from Seller

Mortgage Type*

You may select from the given responses or enter your own below.

Select or enter value

If other, please describe:

Amount Financed*

Rate*

Term*

Down Payment Information

If you have only one source, answer questions 1-5. If you have more than one source, please answer questions 1-10. If a question does not apply, you may enter n/a. For question 1, you may select from the given responses or enter your own.

1a) Down Payment Source

Select

1b) If other, please describe:

2) Dollar Amount

3) Rate

4) Term

5) Monthly Repayment

6) Grant Down Payment Source

7) Dollar Amount

8) Rate

9) Term

10) Monthly Repayment or Loan Forgiveness Term

Is the Down Payment and/or Grant a Second Lien on Your Home?

Yes

Monthly Payments

Monthly Mortgage Repayment

Amount of Monthly Insurance Premium*

Total of All Monthly Payments (Mortgage, Interest, Insurance, Taxes)*

Send me a copy of my responses

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