Empire Real Estate
Home Loans and Property Sales
51 Monroe St.
Suite #1107
Rockville, MD 20850
(240) 603-9794

*Indicates required field
Buyer/Borrower First Name: *
Buyer/Borrower Last Name: *
Address of property to be purchased or refinanced: *
Current Home Address (if different from above):
Date of birth: *
Social Security #: *
Daytime phone number: *
Evening phone number: *
E-mail Address: *
Annual Income: *
Employer name: *
Employer address: *
Employer Phone Number (to verify employment): *
Job title: *
Brief job description:
How long have you worked with this employer: *
If less than 2 years, where did you work previously and for how long:
Number of dependents: *
Amount of downpayment or downpayment percentage (Purchase Only):
Have you declared bankruptcy before: *
Have you had a property foreclosed on in the past 7 years? If yes, SEE BELOW: *
Are you a party to a lawsuit? If yes, SEE BELOW: *
Have you directly or indirectl;y been obligated on any Federal debt which resulted in foreclosure, transfer of the title in lieu of foreclosure, or judgment? If yes, SEE BELOW: *
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? If yes, SEE BELOW: *
Are you obligated to pay child support, alimony or separate maintenance?: *
If you answered yes to the previous question, how much do you pay and what type?:
Is any part of the down payment borrowed? If yes, SEE BELOW: *
Are you a co-maker or endorser on a note? If yes, SEE BELOW: *
Are you a U.S. citizen?: *
Are you a permanent resident alien?: *
Do you intend to occupy this property as your primary residence?: *
Have you had an ownership interest in a property in the past 3 years?: *
If you answered YES to the previous question, what type of property did you own a principal residence (PR), second home (SH) or an investmnet property (IP)? Please put in the correct two (2) letter abbreviation.:
If you answered YES to the previous question, how did you hold the title to the home; solely by yourself (S), jointly with your spouse (SP) or jointly with another p[erson (O)? Please put in the appropriate abbreviation.:
If you answered YES to any of the questions above, please provide a detailed explanation.:

Empire Real EstateHome Loans and Property Sales51 Monroe St.Suite #1107Rockville, MD 20850(240) 603-9794

Empire Real Estate
Home Loans and Property Sales
51 Monroe St.
Suite #1107
Rockville, MD 20850
(240) 603-9794