FFS Mortgage

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You are on a secure area of our web-site. The information that you provide will be held in the strictest of confidence. As a mortgage broker we will have to share this information with potential lenders for credit decision purposes only. However, your information will never be distributed for the purpose of any direct mail, direct e-mail, or any other mailing lists. Also, we are bound by the privacy laws governing mortgage brokerage in the state of Virginia. Besides, most of our business is done on a referral basis. We want you to tell your friends and relatives how great we are so we do not intend to do anything that would make you upset!

PLEASE NOTE: We are licensed as a Virginia Mortgage Broker and are not able to fulfill requests from other states.

Borrowers Info

Please Enter Your E-Mail Address

Please Type Your Full Name (Include Middle Initial and Suffix)

Social Secuirty Number

Co-Borrowers Info (If Applicable)

Please Type Your Full Name (Include Middle Initial and Suffix)

Social Secuirty Number

Enter Your Present Street Address

Address Line 2

City, State and Zip Code

Home Phone and Work Phone (please include area codes)

Loan Amount Requested

What Type of Loan Do You need?
Purchase Refinance 2nd Mortgage Equity Line New Construction

If Puchase What is the Sales Price?

If Refinance or 2nd Mortgage what is the estimated value of the property?

For What Type of Property?
Primary Residence Second Home Rental Property

What Length of Mortgage Would You Prefer?
15 Year 20 Year 30 Year

What Type of Mortgage Are You Interested In?
Fixed Rate Adjustable Rate Bi-Weekly Balloon

Employment Info for Borrower

Employer Name

Your Title

How Many Years in this line of Work?

Are you Self Employed?
Yes No

How are you paid?
Salaried Hourly Commission Part-Time

Enter Your Monthly Gross Base Pay

Enter Your Avg Monthly Overtime Pay

Enter Your Avg Monthly Bonus Pay

Enter Any Other Monthly Income

Enter Your Total Gross Monthly Income

Employment Info for Co-Borrower (If Applicable)

Borrowers Current Monthly Debt

Current Mortgage (or Rent Payments)

Other Mortgages (monthly payments)

Auto Loan 1

Auto Loan 2

Other Loans 1

Other Loans 2

Charge Cards 1 (enter minimum monthly payment)

Charge Cards 2 (enter minimum monthly payment)

Charge Cards 3 (enter minimum monthly payment)

Other Monthly Payments 1

Other Monthly Payments 2

Total Monthly Payments (do not include utilities)

Co-Borrowers Current Monthly Debt

Current Mortgage (or Rent Payments)

Other Mortgages (monthly payment)

Auto Loan 1

Auto Loan 2

Other Loans 1

Other Loans 2

Charge Cards 1 (enter minimum monthly payment)

Charge Cards 2 (enter minimum monthly payment)

Charge Cards 3 (enter minimum monthly payment)

Other Monthly Payments 1

Other Monthly Payments 2

Total Monthly Payments (do not include utilities)

Is there anything else we should know about?

By submitting this form you are giving First Financial Services, Inc. permission to obtain a copy of your mortgage credit report for the purpose of obtaining a mortgage loan. This is not a commitment to offer credit. All applications are subject to credit, income and property approval. This is for information purposes only and does not conform to RESPA. This form will be submitted using your e-mail client. We will then have your e-mail address as a form of contacting you. If you wish for us not to have your e-mail address you may print this form and fax it to us at (540)721-1889. Also, because you are in a secure area of our site and your e-mail will be sent to a secure server it is safe and does not need to be encrypted.

How shall we contact you?
Phone E-Mail Postal Mail

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As always we welcome you to phone us with any questions or comments that you may have and if you're in the area please stop by and say "Hi".

First Financial Services, Inc.
130 Scruggs Road, Suite 203
Moneta, VA 24121
Phone: (540) 721-0010 or Fax: (540) 721-0285
Toll Free: (800) 804-0808