First Merchants Bank Mortgage

Start
Information to get started

*	Borrower First Name:

Borrower Middle Name:

*	Borrower Last Name:

*	Borrower Email:

Do you have a co-borrower?

Yes No

Co-borrower First Name:

Co-borrower Middle Name:

Co-borrower Last Name:

Co-borrower Email:

Do you intend to apply for joint credit?

Borrower:

Co-borrower:

Loan Officer:

*	How did you hear about us?:

Referral Name:

*	Credit Check Authorization:

During your mortgage loan application process, this institution performs a credit check that requires us to obtain and confirm information regarding your personal and financial background. This credit check includes, but is not limited to, your marital status, number of dependents, current and past employers, current deposit accounts, current and past consumer credit accounts, and your mortgage and/or rental history.

We AUTHORIZE this Credit Check.

*	Authorization to Receive Electronic Disclosures:

In order to successfully process your mortgage loan application, you must agree to receive certain disclosures from this institution in electronic form rather than paper form. You must also agree to the terms of the eDisclosure Agreement, which include software and hardware requirements and your responsibility to maintain and provide a valid email address. Certain disclosures may be provided to you in paper form as necessary once your mortgage loan application is received.

I AGREE.

= Required

Next >