WSB MORTGAGE SERVICES, INC.
Giving Older American’s “Peace of Mind”
Reverse Mortgage Quote Order Form
**Fill In All Applicable Info Below to Receive an Accurate Quote, Please Print Clearly**
FAX to: 916-965-5726
__________________________________________________________ Loan Officer Name: _____________________________ LO Phone: _________________________ Date of Birth: _________________________ Date of Birth:
______________________________________________________________ Borrower Name: ______________________________________________________________ Co-Borrower Name:
__________________________________________________________________________________________ Address: _______________________________________________________ City: __________________________ Borrower Phone: ________ State: _____________________ Zip Code:
________________________________ Best Time to Call:
$_________________________________________ Estimate of Your Property Value (if any):
$________________________________________ Current Mortgage Amount (if any):
$_________________________________________ Current Monthly Payment on Mortgage (if any):
$________________________________________ Years Remaining to Pay off Current Mortgage:
Why do you need or want the Reverse Mortgage?
What is your biggest concern with the Reverse Mortgage?
_______________________________________________________ Advisor Name (if other than Loan Officer):
_______________________________ Advisor Phone:
WSB Mortgage Services, Inc. 9712 Fair Oaks Blvd Suite C., Fair Oaks Ca. 95628 PH#866-309-6626 FAX#:916-965-5726 www.WSBRM.com