Easy Application - NorthEast USA Our special quick and easy application form below will take you through the qualifying process in just a few minutes. Make sure you fill out all the required fields clearly and thoroughly. Loan Amount $   Loan Purpose Please select one Refinance Debt Consolidation Cashout Refinance Purchase Rate & Term Refinance Second Mortgage Home Equity Line of Credit Foreclosure Refinance 125% Second Mortgage Home Improvement Applicant Information First & Last Name: Applicant Email: Address Street Address: City: State/Prov: Zip Code: How Long At Present Address?: Prior Address (If Less Than 2 Years): Phone Home Phone (Area Code): Work Phone (Area Code): Employment Information Applicant Employer: Self-Employed?: Please make a selection Yes No Address: Years On This Job?: Applicant Social Security Number: # Applicant Gross Monthly Income: $ Co-Applicant Information (If any) First & Last Name: Co-Applicant Email: Employment Co-Applicant Employer: Self-Employed?: Please make a selection Yes No Address: Years On This Job?: Co-Applicant Social Security Number: # Co-Applicant Gross Monthly Income: $ Financials Year Acquired: Original Cost: $ Amount Of Existing Liens: $ Estimate Of Monthly Expenses: $ How Would You Rate Your Credit?: Select your credit rating Excellent Good Fair Poor Subject Property Address (Street, City, State, & Zip Code) Authorization is hereby granted to Coastal Financial Company, LLC to obtain a standard factual data credit report through a credit reporting agency chosen by Coastal Financial Company, LLC. AUTHORIZATION IS HEREBY GRANTED Yes No For Purchase Only: Please Fill Out Appropriate Realtor Information. Realtor Information Realtor Name: Realtor Street Address: Realtor City: Realtor State/Prov: Realtor Zip Code: Realtor Phone(Area Code): Realtor Fax(Area Code): Contact Name: Realtor Email: Purchase Information Purchase Price: $ Deposit: $ Total Down Payment: Amount $ To Finance: COMMENTS AND QUESTIONS Thank you. Your personal loan officer will contact you shortly to discuss your financing requirements. GLOSSARY PAGE

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© Coastal Financial Company "LLC" Mortgage Banker ● Broker ● Portfolio Lender Main Office: 199 Main St Suite#16 ● East Haven, CT 06512 Toll Free Nationwide 1-800-701-4021 Tel. 203-468-9998 ● Fax 203-469-3194 Email: Coastal.Financial@snet.net ● Website: www.coastalfinancialco.com Regional Office: 4A Estate Enighed "The Marketplace" ● St. John, U.S.V.I., 00831

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