Once you have completed the application your information will be sent to Coast Capital Group. A representative from Coast Capital Group may contact you by telephone or email.
Middle Name:
Last Name:
Email:
Phone Day:
--
Ext.
Phone Evening:
--
Referred By:
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Just tell us a little more
Marital Status:
Resident Status:
Date of Birth:
//
SSN:
--
Dependents:
Number:
Age(s) (separated by comma):
Present Address:
Street:
City:
State:
Zip:
Ownership:
years
Former Address (Needed if residing at present address for less than 2 years):
Street:
City:
State:
Zip:
Ownership:
years
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.
I do not wish to furnish this information
Ethnicity:
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Sex:
Female Male
Monthly Income:
Base:
Bonus:
Commission:
Other:
Assets:
Checking:
Savings:
401k:
Other:
A bit about the subject property
Property Usage:
Purpose of Loan:
Purpose of Refinance:
Loan Amount:
Property Value:
Number of Units:
Year Built:
Address of Subject Property:
Street:
City:
State:
Zip:
Coast Capital Group 1601 Pacific Coast Highway Suite 245 Hermosa Beach, CA 90254 Toll Free: 888.998.9088 Ph: 310.798.5500 Fax: 310.798.5510 California Lic #: 01374996
