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Instructions
1. This is your application form.
2. Please fill out as much of the form as possible.
3. When finished click on the submit button.
*The first 7 items with an asterisk are required.
Empire Agent you are working with:
First Name:
*
Last Name:
*
Email:
*
Home Phone Number:
*
Select Loan Type:
*
Select One...
Purchase
Refinance
Extend Credit Line
Extend Home Equity
Other
Select Property Type:
*
Select One...
Single Family Home
Multi-Family Home
Duplex
Condominium
Town Home
New Construction
Waterfront Home
Rental Property
Recreational Property
Vacant Land-Lot
Mobile Home
Select Your Timeframe:
*
Select One...
Less than 1 month
2-3 Months
4-6 Months
More than 6 months
Current Street Address:
City:
State:
Zip Code:
Work Phone Number:
Cell Phone Number:
Enter Code Shown:
*
970 East Main Street, Suite 103
Grass Valley, Ca 95945
530-272-1111
Grass Valley Mortgage
Nevada City Mortgage
Penn Valley Mortgage
Lake Wildwood Mortgage
Lake of the Pines Mortgage
Nevada County Mortgage
Nevada County Mortgage is a dba of Empire Home Loan Corporation
Licensed by the California Department of Real Estate,
License #01213224.
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