GREGG LONG We would love to hear from you! Please fill out this form and we will get in touch with you shortly.1 Borrower's Information2 Co-Borrower's InformationBorrower's InformationBorrower's InformationReferrred By:* First Last How did you hear about us?*FriendWebsiteRealtorNewspaperPhone BookNone of the aboveBorrower’s Name-As you desire to take title* First Middle Last Social Security #*Birth Date*Daytime Phone*Evening PhoneEmail Address* Current Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Rent or own?*RentOwnHow long at this address?*Current Payment*Previous home address if less than 2 years at current addressMust be filled out if less than 2 years at current residence.Previous Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current EmploymentSelf Employed*YesNoCurrent Employer*Current Employer's Phone*Salary*How long at this job?*Additional IncomeSocial SecurityRetirement/ PensionRetirementPart TimeOtherNone of the aboveAdditional Income AmountPrevious EmploymentMust be filled out if less than two years.IF LESS THAN 2 YEARS AT YOUR JOB PREVIOUS EMPLOYERPrevious Employer's PhoneEthnicity & GenderBorrower I do not wish to share this information.EthnicityHispanicNot Hispanic or LatinoRaceAmerican Indian or Alaskan NativeNative Hawaiian or Other Pacific IslanderAsianWhiteBlack or African AmericanSex:FemaleMaleE-Authorization and Consent*I/We consent to First American Mortgage, Inc. using information we provided to obtain credit report(s) and to the electronic delivery by First American Mortgage, Inc. of all correspondence, disclosures and documents.Will there be a Co-Borrower?YesNoCo-Borrower's InformationCo-Borrower's InformationCo-Borrower’s Name-As you desire to take title* First Middle Last Social Security #*Birth Date*Daytime Phone*Evening PhoneEmail Address* Current Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Rent or own?*RentOwnHow long at this address?*Current Payment*Co-Borrower's Previous Address if less than 2 years at current addressMust be filled out if less than 2 years at current residence.Previous Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Co-Borrower's Current EmploymentSelf Employed*YesNoCurrent Employer*Current Employer's Phone*Salary*Co-Borrower's Years on Job*Additional IncomeSocial SecurityRetirement/ PensionPart TimeRetirementOtherNone of the aboveAdditional Income AmountCo-Borrower's Previous EmploymentMust be filled out if less than two years.Previous EmployerPrevious Employer's PhoneCo-Borrower's Ethnicity & GenderCo-Borrower I do not wish to share this information.EthnicityHispanicNot Hispanic or LatinoCo-Borrower's RaceAmerican Indian or Alaskan NativeNative Hawaiian or Other Pacific IslanderAsianWhiteBlack or African AmericanCo-Borrower's Sex:FemaleMaleEmailThis field is for validation purposes and should be left unchanged.Online Form – Application Form Borrower’s InformationPowered by Formstack First American Mortgage, IncNMLS#:208913Address:1501 S. Ranchwood Blvd, Yukon, Ok. 73099Phone:405-354-0426