Online Application
Loan Information and Purpose of Loan <> (Items marked with " * " are required for submission. )
Estimated Value of Home: Purpose of Loan:*
Loan Amount Desired:  
Please select a purpose of loan.
      If purpose of loan is other, please explain below:
     
Borrower Information
I. Borrower's Name: (include Jr. or Sr. if applicable)
First Name:* Middle Name: Last Name:*

Borrower's first name is required.
Borrower's last name is required.
Email Address:* Social Security #* Home Phone* (incl. area code) 

Email address is required.
Please enter in email@address.com format.		 - -
Social security number is required.		 ( ) -
Home phone number is required.
     
Present Address (street, city, state ZIP): Own *   Rent*
Please select a type of present address. 		Number of Years*
Number of years is required.
Street:* City:* State:*(Abvr. ) Zip Code:* 

Street address is required.
City is required.
State is required.
Zip code is required.
Gross Monthly Income*    
Gross monthly income is required.
II. Co-borrower's name: (include Jr. or Sr. if applicable)  Do you have a Co-borrower? Please reply the question.
 
Authorization to Release Information*
You are free to disagree or agree with the acknowledgment below, however, please understand that if select 'DISAGREE' that your application automatically cannot be processed or pre-approved.
I authorize Prime Choice Funding, Inc. to verify any and all information that is needed to complete the loan process. Such information includes, but is not limited to, employment history and income; bank, money market and similar account balances; credit history; and copies of income tax returns.
 
I Agree  I Disagree
Please select an authorization to release your information.
 
Additional Information
When would you like us to contact you:* Please select when would you like us to contact.
How did you hear about us?* Please select how did you hear about us.
If you answered, 'G, H, or I' to the above question, please specify the first and last name of the contact person who referred you to PrimeChoiceFunding.com in the box on the right to ensure that proper credit is given to the appropriate loan originator.
 
Borrower/Co-borrower Signatures
Borrower's Signature*
Type in Name
Your name is required.		 Date *
Date is required.
Co-borrower's Signature
Type in Name		 Date
 

Call us today at (877) 787-7463
Home l Company l Mission Statement l Resources l Mailing List l Terms of use l Privacy Policy l Contact Us l
Copyright 2008 Prime Choice Funding, Inc. All rights reserved.