Mortgage Short Form

Purpose of Loan:

Purchase

Refinance

Year Acquired:

Original Cost: $

Amount Existing Liens:

Purpose of Refinance:

Describe Improvements:

Made	To Be Made

Cost: $

Contact Name:

Address:

Phone Number:

Contact Time Preference:

Morning

Evening

Name & Address of Employer:

Are you self employed?

Yes

Business Phone:

Years on the Job:

Are you currently an InBank Customer:

Yes

Our compensation structure rewards customer retention.....

InBank understands that growth starts with retaining the valuable client base we’ve worked so hard to build.