70 Wells Avenue
Newton, MA 02459
Tel. (617)
332-4700
Fax (617) 244-9361
info@barsh-cohen.com
Submit Borrower/Buyer Information
Borrower Information
Personal Information
Your New Lender:
*
Your Name:
*
Loan/Transaction Type:
Are you Purchasing a house?
Are you Refinancing your Existing Mortgage?
Are you taking out an Equity Mortgage?
Your Telephone:
Home:
Work:
Your Email Address:
Co-Borrower:
Co-Borrower Telephone:
Home:
Work:
Property Address:
*
City
*
, State
*
, Zip:
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Your Current Address:
City, State, Zip:
MA
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Purchase Information
Title Preference:
Joint Tenancy
Tenants in Common
Tenants by the Entirety
Individually (One Owner)
Individually (One Owner)
Your Attorney (If any or, If not our office):
Your Attorney Address:
City, State, Zip:
MA
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Phone:
Your Insurance Agency:
Phone:
Refinance Information
Current First Mortgage Lender:
Loan/Account Number:
Lender Telephone:
Current Equity / Second Mortgage Lender:
Loan/Account Number:
Lender Telephone:
Notes or Special Instructions to us:
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