American Mutual Mortgage

Broker's Loan Request

Loan Submission Form
Please complete all fields. Fields marked as "(Required)" must be completed.

Broker Information

Broker's Name (Required)

Company Name

Broker's Mailing Address

Broker's Phone (Required)

Broker's Email (Required)

Borrower Information

Borrower Name: (Required)

Employment status:

Employed	Retired
Self-Employed	Unemployed

Credit status:

Good	Bad
Fair	Non-existent

Are there any bankruptcies or judgments at this time?

Yes No

Property Information

Type of property: (Required)

Vacant Land	1-4 Units
Commercial	Single Family Residence
Church	Mixed use
Other	Multi-family

Estimated property value:

Loan amount desired: (Required)

Address or APN (Assessor's Parcel Number)
of subject property:

County in which property is located:

Loans currently against the property
(check all that apply): (Required)

None
1st TD 2nd TD 3rd TD
Other:

Additional Information

Are there any special conditions
to the requested loan? Please explain:

American Mutual Mortgage
19510 Ventura Blvd. Suite 214
Tarzana, CA 91356 USA

Office: (818) 654-9790
Fax: (818) 961-0041

Email: info@AmericanMutualMortgage.com

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American Mutual Mortgage is licensed by the California Department of Real Estate, License #00882327
DRE Licensee Information Telephone Number (916) 227-0931