Rockland Financial On-Line Application

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On Line Application

Welcome to Rockland Financial On-Line Application. For security purposes,
this application does not require any sensitive information.

Once you have completed your On-Line Application, it will be emailed to our office,
and we will contact you to verify receipt. We will also let you know what items will be
required to continue processing your application (such as the sensitive items not
covered in this On-Line Application).

We look forward to your application,
Rockland Financial

Borrower #1

Full Name:
Street Address:
City, State, Zip:

Borrower #2

Full Name:
Street Address:
City, State, Zip:

Employment Information Borrower #1:

Employer:
Employer Street Address:
Employer City, State, Zip:
Position Held:
Number of Years on Job:
Office Telephone Number:
Gross Monthly Income:
Other Income:
E-mail address:

Employment Information Borrower #2:

Employer:
Employer Street Address:
Employer City, State, Zip:
Position Held:
Number of Years on Job:
Office Telephone Number:
Gross Monthly Income:
Other Income:
E-mail address:

Liabilities:
Do not disclose account numbers or balances.

Account numbers are not necessary at this stage of your
loan inquiry. However, youroverall monthly debt service is an important
consideration in loan qualification. In the space below, list your existing
creditors and related monthly payments.

Examples:
Creditor: Home Sweet Mortgage Approximate Monthly Payment: 1125
Creditor: National Motors Approximate Monthly Payment: 325
Creditor: Visa Approximate Monthly Payment: 75

Creditor: Approximate Monthly Payment:
Creditor: Approximate Monthly Payment:
Creditor: Approximate Monthly Payment:
Creditor: Approximate Monthly Payment:
Creditor: Approximate Monthly Payment:

Additional Information:
Use the space below to provide any additional information about yourself or the property.

Loan Term and Type:
Loan Amount $ Interest Rate

Term: ................. 30 Year 15 Years
Type:.................. Fixed Adjustable
Purpose: .............. Purchase Refinance

Submitting Your Application:
Congratulations! You have just completed your On-Line Application. Press the button
below to submit your application.

Press to
.

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Rockland Financial
Independently Owned and Operated by Linda Gross

PO Box 12624
Marina Del Rey, CA 90295
rockland@beachnet.com
310.823.6133 phone
310.848.5585 pager
310.823.1390 fax

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