Mountain Valley Home Mortgage

Need to talk with a live Mortgage specialist?

Call us toll free at:
1-866-370-5261

Guaranteed no-hype home mortgages. We will not low-ball you only to raise your rates at a later date.

Occurring simulataneously with a home equity loan or cash-out refinance for the purpose of consolidating and/or paying off debt, you may apply to have Mountain Valley Mortgage negotiate on your behalf to obtain an reduced pay-off amount on your existing debt.

To initiate that process, please complete the application form below:

Your Information

First Name

Last Name

Present Street Address
City	State	Zip

Home Phone		Work Phone		Cell Phone
Email

Loan Information

Type of loan associated with this Application:

Cash-Out Refinance

Debt Consolidation

Home Improvement

HELOC

Loan Amount
$

Estimated Cash-out
$

Other funds available
$

Your Social Security Number

I give Mountain Valley Mortgage
permission to obtain my credit report
Yes No

PLEASE LIST ALL DEBTS

(student loans, car loans/leases, personal loans, credit cards, lines of credit, etc.)

Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment
Name of Creditor	Balance	Monthly Payment

I certify that I provided Mountain Valley Mortgage authority to pull my credit and to represent me and my interests in dealing and negotiating with my debtors for the purposes obtaining a lowered pay-off amount. I understand that, if I accept the amounts negotiated, these debtors will be paid at the time of closing. I also understand that Mountain Valley Mortgage will charge me at 23.7% of my total debt savings and that said fees will be paid to Mountain Valley Mortgage at the time of closing. I have downloaded the Authorization Letter which I am obligated to sign and return to Mountain Valley Mortgage before they can initiate negotiations.

My Acknowledgement

Credit Card Information

You will be charged $75.00 as an initial consultation fee.

I prefer to pay by check:

Name on Credit Card:

Type of Credit Card:

Credit Card Number:

Card Verification Number:

Expiration Date:

Amount of Payment:

$75.00

Billing address (where you receive your credit card bills), if different from above

Street:

City:

State:

Zip Code:

This document will not be "signed" in the sense of a traditional paper document. To verify the contents of this form, the signatory must enter any combination of alpha/numeric characters that has been specifically adopted to serve the function of the signature, preceded and followed by the forward slash (/) symbol. Acceptable "signatures" could include: /john doe/; /jd/; and /123-4567/. For example: if your name is John Miller, you could type /John Miller/ below.

Signature: Date: