
REQUEST FOR VERIFICATION OF RENT OR MORTGAGE
PART I - REQUEST
PART II - TO BE COMPLETED BY LANDLORD/CREDITOR
X
X
We have received an application for a loan from the applicant listed below, to whom we understand you rent or have extended a loan.
INSTRUCTIONS: LENDER - Complete items 1 thru 8. Have applicant(s) complete item 9. Forward directly to ??lender?? named in Item 1.
LANDLORD/CREDITOR - Please complete Part II as applicable. Sign and return directly to the lender named in Item 2.
1. TO (Name and address of Landlord/Creditor) 2. FROM (Name and address of lender)
3. SIGNATURE OF LENDER 4. TITLE 5. DATE 6. LENDER'S NUMBER
7. INFORMATION TO BE VERIFIED.
PROPERTY ADDRESS ACCOUNT IN THE NAME OF: ACCOUNT NO.
MORTGAGE
LAND CONTRACT
RENTAL
8. NAME AND ADDRESS OF APPLICANT(S) 9. SIGNATURE OF APPLICANT(S)
RENTAL ACCOUNT MORTGAGE ACCOUNT LAND CONTRACT
Tenant has rented since
to
Date mortgage originated
Amount of rent $ per
Original mortgage amount $
Is rent in arrears? Yes No
Current mortgage balance $
Amount $ Period
Monthly Payment P & I only $
Number of times 30 days past due*
Payment with taxes & ins. $
Is account satisfactory? Yes No
Is mortgage current? Yes No
Is mortgage assumable? Yes No
Satisfactory account? Yes No
Interest rate
FIXED ARM
FHA VA
FNMA CONV
Next pay date
No of late payments*
Insurance agent:
* Number of times account has been 30 days overdue in last 12 months
ADDITIONAL INFORMATION WHICH MAY BE OF ASSISTANCE IN DETERMINING APPLICANT(S) CREDIT WORTHINESS
SIGNATURE OF CREDITOR TITLE DATE
PHONE NO.
The confidentiality of the information you have furnished will be preserved except where disclosure of this information is required by applicable
law. The form is to be transmitted directly to the lender and is not to be transmitted through the applicant or any other party.
Calyx Form - vom.frm (11/07)
Goldenloan.com
202 Fashion Ln Suite 223
Tustin, CA 92780
(P) 714-505-0010
(F) 714-866-3205
Goldenloan.com, NMLS# 357267