Industry Tools - Reverse Mortgage



Loan Officer Doug Vairo

Loan Officer
Loan Officer  

Loan Officer Doug Vairo


This is NOT an application for a Reverse Mortgage! Fill out and submit the form below and a Reverse Mortgage Specialist will answer your questions. FREE OF CHARGE!

First Name:
Last Name
SR. JR. None
Date of Birth:
Are you on title?
Yes N0
Property Address:
Property Type:

If you selected Multi-Family please fill in number of units here.

Current Value of Home:

Total balance of ALL loans or mortgages on home. If zero balance state zero to this question.

Do you have? Zero Mortgage Balance Remaining Mortgage Balances

My Total Balances Are:
How much is your current monthly mortgage payment?:
I am inquiring on behalf of:
Home Phone Number:
Cell Phone Number:
Email Address:

I am looking to use the money for: (please check as many as apply)

 Stop Foreclosure

 Catch up on my bills
 Go on vacation
 Eliminate my current monthly mortgage
 Fix up my home
 Give money to my children/grandchildren
 Pay for medical expenses
 Addtn'l income for as long as I live in my home

 Other - Please explain

Currently I have:

 No extra money at the end of each month
 I'm falling behind every month
 I have a lot of extra money every month




Who will be assisting you with your decisions? (check all that apply)

 Just me
 Tax Advisor
 Investment Counselor




I want to complete this loan

 As soon as I can
 In the next 60 days
 Next year
 Just looking for Free info
 I would like to refer clients to you





Loan Officer


Loan Officer




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