Borrower Interest Form

Don’t let financing stand in the way of your aspirations—take charge of your future! Complete our Borrower Interest Form below and we’ll connect you with a loan expert to discuss your options.

Borrower Info

Name

First

Last

Phone

Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

How long have you lived at this address?

Are you the homeowner?

YesNo

License Number

Employment Information

Current or Most Recent Employer

Position / Title

Phone

Employer Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Time with Employer

Gross Monthly Income

Did you work for this Employer for less than 2 years?

YesNo

Housing, Assets & Other Obligations

Housing Status

Monthly Housing Payment

Utilities Payment

Other Payments

Will you be submitting Co-Borrower Information?

YesNo

Consent

I Agree

I certify that the information provided is true and complete. I authorize Legacy Loans to obtain a consumer credit report and verify my employment and income as necessary to process this application. I understand that false statements may result in denial or cancellation of credit. I acknowledge and have read the terms and conditions, information sharing policy and privacy policy.