Combs Team Mortgage Adoption Program

Intake Form

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* 1. Contact Info

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Primary Home Property Address

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* 3. Do you own additional property(s)

Yes

No

If Yes, please list address(es) in the box below:

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* 4. Primary Home Estimated Remaining Mortgage Balance(s)

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* 5. Interest Rate

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* 6. Is it a Fixed or Adjustable Rate?

Fixed Rate

Adjustable Rate (ARM)

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* 7. What is your loan term?

10 Years

15 Years

20 Years

25 years

30 Years

40 or More Years

I have a Balloon Mortgage

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* 8. What type of Loan did you obtain?

Conventional

VA

FHA

USDA

Jumbo

Other

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* 9. Once this survey is submitted and received, we will contact you within 1 business day to schedule your introductory call with Steve. Are there any pressing concerns, answers to questions or goals that you'd like to make sure we cover in this appointment?