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Short Application
Our short application is an easy and fast way to request a mortgage. Please provide the following information.
Personal Information
*First Name:
*Last Name:
*Email:
Referral Name:
Home Phone:
( ) -
Cell Phone:
( ) -
Work Phone:
( ) - Ext.
Marital Status:
Are you a U.S. citizen?
Date of Birth:
 (mm/dd/yyyy)
*Credit Check Authorization:
Number of Dependents:
Dependent Age(s):
Separate ages by commas.
*Loan Officer:
 
Current Address
Street Address:
City:
State:
Zip:
-
Years at this Address:
 Years     Months
Rent or Own:
 
Subject Property
Purpose of Loan:
Please Specify  
Property Usage:
Loan Amount:
$
Present Value/Purchase Price:
$  
Number of Units:
 
Year Built:
Subject Property Address:
 
City:
State:
We only accept applications for the states listed.
Zip:
-
 
Monthly Income
Submitting income from alimony, child support, or separate maintenance income is optional if you do not want to use that income for qualification purposes.
Base Income:
$
Bonuses:
$
Commission:
$
Other Income:
$
 
Assets
Checking:
$
Savings:
$
Retirement Funds:
$
Mutual Funds:
$
Other:
$
 
Information for Government Monitoring Purposes
The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.
Option:
   
Sex:
Ethnicity:
Race:



* Privacy Policy:

Privacy Policy Statement

This is the web site of Primary Residential Mortgage, Inc. .

Our postal address is
1480 No. 2200 W.
Salt Lake City, UT 84116

We can be reached via e-mail at Compliance@primeres.com
or you can reach us by telephone at 1-800-255-2792 (opt. 8, opt 5).

Primary Residential Mortgage, Inc. is committed to ensuring your privacy.  We respect and protect the privacy of those who use our website.  Therefore, we want you to know what information is collected and how it is used. 

Primary Residential Mortgage, Inc. does not share or sell your personal information with outside companies for their promotional use.  Please see our Consumer Privacy Notice for a full explanation of how we collect, use and share personal information and what steps you can take to limit sharing of your information.

Because of the financial nature of our business, our websites are not designed to appeal to anyone under the age of 18. Therefore, we do not knowingly attempt to solicit or receive any information from children.

If you feel that this site is not following its stated information policy, you may contact us at the above addresses or phone number.

Information We Collect

When you visit this site, we may collect certain types of information from you, such as information you voluntarily provide including your e-mail address, name and address, telephone number, survey information and/or site registrations. We may also collect aggregate information on what pages you access or visit to track trends in the use of our website. 

With respect to Ad Servers: We do not partner with or have special relationships with any ad server companies.

Protecting the Confidentiality and Security of Your Information

We employ industry recognized security safeguards to help protect the personally identifiable information that you have provided to us from loss, misuse, or unauthorized alteration. Only those persons who need it to perform their job responsibilities are authorized to access your information. We take commercially reasonable precautions to protect your information and limit disclosure by maintaining physical, electronic and procedural safeguards in compliance with Federal Law.

Cookies

We may send “cookies” to your computer primarily to enhance your online experience.  “Cookies” are text files sent from a Web server and stored on your computer to assist in identifying you as unique customer and store your personal preferences as well as technical information.  Cookies can be either stored on your computer until you delete them or last only until you close your browser.

You have the ability to accept or decline cookies. Most Web browsers automatically accept cookies, but you can usually modify your browser setting to decline cookies if you prefer.

Co-Borrower
Do you have a co-borrower?  
* = Required

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Primary Residential Mortgage, Inc.
1220 E. Joppa Road, Towson, MD  21286
Office:  (443) 384-3902
jwald@primeres.com
Copyright © 2017 Primary Residential Mortgage, Inc.
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