OMEGA GOLD
DEVELOPMENT GROUP, INC.
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Personal Information Questionnaire
NOTE: MD residents only; this is
not
a loan application.
Applicant Information
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:
(5 digits)
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
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IA
KS
KY
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ME
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NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Co-Applicant Information
First Name:
Last Name:
Contact Information
Daytime Phone:
Evening Phone:
Email:
Financial Information
Loan Type:
Purchase
Refinance
Home Equity
Loan Amount:
(USD)
Property Information
Property Type:
Single Family Residence
Duplex
Mobile
Condo
Townhome
Occupancy:
Primary Residence
Secondary Investment
Investment
Purchase Price:
(USD)
Appraised Value:
(USD)
Mortgage Balance:
(USD if applicable)
Other Information
Comments:
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