REQUEST FOR VERIFICATION OF RENT OR MORTGAGE
We have received an application for a loan from the applicant listed below, to whom we understand you rent or have extended a loan.
INSTRUCTIONS: LENDER- Complete items 1 thru 8. Have applicant(s) complete item 9. Forward directly to lender named in item 1.
LANDLORD/CREDITOR- Please complete Part II as applicable. Sign and return directly to the lender named in item 2.
PART I - REQUEST
1.TO (Name and address of Landlord/Creditor)
2. FROM (Name and address of lender)
3.SIGNATURE OF LENDER
4. TITLE
5.DATE 6.LENDERS NUMBER
7. INFORMATION TO BE VERIFIED
_____MORTGAGE
_____LAND CONTRACT
_____RENTAL
_____OTHER ________________
PROPERTY ADDRESS ACCOUNT IN THE NAME OF: ACCOUNT NO.
8.NAME AND ADDRESS OF APPLICANT(S) 9. SIGNATURE OF APPLICANT(S)
PART II – TO BE COMPLETED BY LANDLORD/CREDITOR
____MORTGAGE ACCOUNT ____ LAND CONTRACT
RENTAL ACCOUNT
Tenant has rented since ______________________
To _____________________
Amount of rent $ _________ per ______________
Is rent in arrears ? Yes ________ No ___________
Number of times 30 days past due* ____________
Is account satisfactory ? Yes _______ No________
_________________________________________
Date mortgage originated ________________
Original mortgage amount $ ______________
Current mortgage balance $ ______________
Monthly Payment P & I only $ ____________
Payment with taxes and ins. $ _____________
Is mortgage current ? Yes______ No_______
Is mortgage assumable ? Yes_____ No ______
Satisfactory account ? Yes ______ No ______
Interest rate ___________________________
FIXED_____________ ARM_____________
FHA_______________ VA_______________
FNMA_____________ CONV____________
Next pay date _________________________
No of late payments*___________________
Insurance agent: _______________________
_____________________________________
* Number of times account has been 30 days overdue in the last 12 months
ADDITIONAL INFORMATION WHICH MAY BE OF ASSISTANCE IN DETERMINING APPLICANT(S) CREDIT WORTHINESS
SIGNATURE OF CREDITOR TITLE DATE
The confidentiality of the information you have furnished will be preserved except where disclosure of this information is requires by applicable law. The form is to
be transmitted directly to the lender and is not to be transmitted through the applicant or any other party.
GFI- form VOM rev. 6-5-2002
