Request for Verification of Rent or Mortgage 1 Part-1 Request 2 Part-2 To be completed by Landlord/Creditor 3 Additional Information To (Name and address of Landlord/Creditor) From (Name and address of Landlord/Creditor) Title Select Date Lenders Number Information to be verified MortgageLand ContractRentalOther Property Address Account in the Name of Account Number Name of Applicant(s) Address of Applicant(s) Previous Next Rental Account Tenant has rented since To Amount of Rent $ Per Is rent in arrears? YesNo Number of times 30 days past due* Is account satisfactory? YesNo Mortgage Account Date mortgage originated Original Mortgage amount $ Current Mortgage Balance $ Monthly payment P&I only $ Payment with taxes and ins. $ Is mortgage current? YesNo Is mortgage assumable?YesNo Satisfactory account YesNo Land Contract Interest Rate Fixed ARM FHA VA FNMA CONV Number of late payments Number of late payments* Insurance Agent *Number of times account has been 30 days overdues in the last 12 months Previous Next Additional information which may be of assistance in determining applicants creditworthiness Title Date Signature of Creditor Or Enter your digital signature in the right field. Previous Next Δ