Free Assessment FormAll fields mandatory unless indicated otherwise 1. What property type is the home you're considering a reverse mortgage for: * Please select one House Townhouse Condo Duplex/Triplex/Quadplex Manufactured Home Other 2. What is the estimated value of your home (in $)? * eg. $200,000, $500,000, $1 m 3. What is your planned use for the reverse mortgage funds? Choose as many as you like - but at least one Major Purchase Travel Health Case Income/Investment Home Renovation Pay Debt Estate Planning Family Gifts 4. Do you have any debts - such as a mortgage, line of credit, credit card etc.? * If your answer is no please continue to Question #5 Yes No 4a. What is your existing mortgage balance - in $? Leave blank if none 4b. What Line Of Credit balances do you have - in $? Leave blank if none 4c. Any other debts you have (credit cards, car loan, etc) - in $? Leave blank if none Your Income And Credit Information Your credit score and income is not so important for a reverse mortgage. However, our job is to advise you on the best option for you - knowing this information will help us decide if there might be a better mortgage option. 5. Approximate Household Income * Includes any pension or other income. Just an estimate. By 'household' we mean you and anyone else on title or living in the property. $0 to $30,000 $30,000 to $60,000 $60,000 to $90,000 $100,000+ Not Sure 6. Can You Give Us An Estimate Of Your Credit Score? * Just an estimate - choose 'not sure' if you're not sure. If there is more than 1 person on title, choose the lowest of the applicant. Good (eg. 680+) Fair (eg. 640-680) Ok (eg. 600-640) Bad (eg. under 600) Don't Know/Not Sure 7. Property Address Information * The postal code will assist us in assessing how much reverse mortgage you qualify for. 8a. Main Applicant - Title Mr Mrs Ms. Miss Other 8b. Name * First Name Last Name 8c. Phone (Optional) (###) ### #### 8d. Email * 8e. Date of Birth * This is necessary, as your date of birth drastically impacts how much reverse mortgage is available. MM DD YYYY 8f. What is your marital status? * Married Widowed Divorced Single Other 9a. Is there a living second applicant? * Someone else who is also the homeowner or on title to the home? Yes No 9b. Second Applicant Title Mr Mrs Ms. Miss Other 9c. Second Applicant Name First Name Last Name 9d. Second Applicant - Date Of Birth This is necessary, as it drastically impacts how much reverse mortgage is available. MM DD YYYY Thank you!
