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30 Under 40
American SystemBuilt Mortgage
Div. of American Home Bank, N.A. 877-BANK-AHB
(877-226-5242)
BankAHB.com
General Information
How did you hear about American System Built Mortgage?
Are you currently working with a Loan Officer?
I am not currently working with a loan officer
Lorna Brown
John Wettig
Borrower Name:*
Co-Borrower Name:
Current Street Address
Address Line 1:*
Address Line 2:
City:*
State:*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:*
Rent or Own:
Rent
Own
How Long?
Selling Home?
Yes
No
Current Value:
Home Phone:*
Cell Phone:
Email:
Employment Information
Borrower Gross Income:
Borrower Self Employed:
Yes
No
Borrower Work Phone:
Co-Borrower Gross Income:
Co-Borrower Self Employed:
Yes
No
Co-Borrower Work Phone:
Current Monthly Payments
Mortgage Payment(s):
Rent Payment(s):
Car Payment(s):
Credit Card(s):
(Minimum Monthly Payment)
Student Loan(s):
Other:
Please List:
Other:
Please List:
Other:
Please List:
Details About Your Project
Manufacturer:
Dealer Name:
General Contractor Name:
Primary Home or Second Home:
Primary
Secondary
When do you plan to break ground?
0-3 months
4-7 months
8-12 months
Over 12 months
Own Land?
Yes
No
How Many Acres?
Land Value?
Amount Owed?
Subject Property Address Line 1:
Subject Property Address Line 2:
City
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code:
Kit Price:
Total Construction Costs (not including kit price)
Have you paid any deposits for your home?
Yes
No
If yes, how much?
Livable Square Footage:
(Above Grade)
Bedrooms:
Bathrooms:
Credit Authorization
I authorize American SystemBuilt Mortgage ("ASBM") to obtain my credit report from a credit-reporting agency. I also authorize ASBM to provide my credit report to any affiliate or investor of ASBM for their review. I understand that I can obtain this report from a credit-reporting agency in accordance with the Fair Credit Reporting Act. I also understand that if I have questions, disputes or comments about the information on my credit report, I must contact the credit-reporting agency to address these issues. This authorization is not an application for credit nor is it a request to ASBM to consider an application from me for credit.
Borrower's Full Name:
Social Security Number:
Date of Birth:
Co-Borrower's Full Name:
Social Security Number:
Date of Birth:
Questions/Comments:
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*Required
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Copyright 2007 American Home Bank N.A.
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