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Instructions
1. Use this form to request mortgage information.
2. Please fill out as much of the form as possible.
3. When finished click on the submit button.
*Items with an asterisk are required.
First Name:
*
Last Name:
*
Street Address:
City:
State:
Zip Code:
Email:
*
Home Phone Number:
*
Work Phone Number:
Cell Phone Number:
Fax Number:
Pager Number:
Select Loan Type:
*
Select One...
Purchase
Refinance
Extend Credit Line
Extend Home Equity
Other
Select Property Type:
*
Select One...
Single Family Home
Multi-Family Home
Duplex
Condominium
Town Home
New Construction
Waterfront Home
Rental Property
Recreational Property
Vacant Land-Lot
Mobile Home
Select Your Timeframe:
*
Select One...
Less than 1 month
2-3 Months
4-6 Months
More than 6 months
Additional Information:
Enter Code Shown:
*
Regency Mortgage, Inc.
- Denver, Colorado
Office Phone:
(303) 885.6908
Fax:
(303) 371.2584
Cell Phone:
(303) 885-6908
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