Reverse Mortgage Questionnaire

Full Name

Phone *

Email *

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Do you have a co-borrower?

Yes

No

Is there a Non-borrowing Spouse (NBS)?

Yes

No

Borrower's Date of Birth

NBS Date of Birth

Co-borrower's Date of Birth

Co-borrower's Marital Status

Married

Unmarried

Marital Status

Married

Unmarried

NBS Marital Status

Married

Unmarried

Transaction type

Purchase

Refinance

What’s your goal with a reverse mortgage?

Property repairs

Pay off debt

Cash Out

Cover healthcare costs

Other

What is your estimated current home value? *

Current property type *

Single-Family

Condo

Townhome

Other

How long have you lived in the home?

Current Mortgage Balance

What’s your estimated credit score?

740+

700–739

660–699

620–659

Below 620

Not sure

How soon are you considering to move forward?

Within 3 months

3–6 months

6+ months

Best time to contact you

Morning
Afternoon
Evening
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