Great Plains Mortgage Company - Tulsa, OK - Online Mortgage Application

BORROWER
First Name
Middle
Last Name
Date of Birth
Social Security Number
Employer
Occupation
How Long	years
Gross Monthly Income
Current Address
Current City
Current State
Zip Code
CO-BORROWER
First Name
Middle
Last Name
Date of Birth
Social Security Number
Employer
Occupation
How Long	years
Gross Monthly Income
Current Address
Current City
Current State
Zip Code

PROPERTY INFORMATION
Street Address
City	State
Zip Code	Property Type
Estimated Value of Property to be Financed
Purpose of Loan

DEBTS
First Mortgage
Lender	Mortgage Balance	Monthly Payment Amt
Second Mortgage
Lender	Mortgage Balance	Monthly Payment Amt

CONTACT INFORMATION
Referral/Loan Officer	How did you hear about us?
Home Phone	Work Phone
Best time to call	Email

CREDIT AUTHORIZATION AND SUBMISSION

By submitting this application and typing my electronic signature below, I authorize Great Plains Mortgage Company to verify any information contained in this application through a Consumer Credit Reporting Agency.

Type Name in field below to electronically authorize this application.

Borrower's Name

Co-Borrower's Name

Date