Ocean State Reverse Financing, Inc.

Questionnaire

Step One: Fill out the secure online questionnaire below or print, fill it out, and mail the PDF below.
This is not a formal application. The purpose of the questionnaire is to provide us with basic information about you and your home. This information will be kept strictly confidential and will be used only for processing your reverse mortgage application.

Questionnaire
(PDF: 26 KB / 1 page)

Questionnaire
(Downloadable Word Document)

*Note: Please fill out this form completely. If there is an option that does not apply to you, please choose or type "N/A".

Applicant
First Name
Middle Initial
Last Name
Suffix
Date of Birth

Co-Applicant
First Name
Middle Initial
Last Name
Suffix
Date of Birth

Address
Street
City
State
Zip Code
Telephone

Is this your primary Address
Yes No

Whose name is on the title of the property?


What is the estimated value of your property?


Do you have a mortgage(s) on your property?
Yes No

If yes, what is/are the mortgage balance(s)


Are there any additional liens on your property?
Yes No

If yes, what is/are the lien(s) and balance(s)
Lien(s)
Balance

Please choose the payment plan that you are considering:
Monthly Payments
Line of Credit
Lump Sum
Combination

How did you hear about Ocean State Reverse Financing, Inc.? (Choose One)
Newspaper
Yellow Pages
Website
Professional Referral
Personal Referral
Television
Radio
Direct Mail
Other

Note: This information will be kept strictly confidential and will only be used for processing your mortgage application.

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