Countryside Mortgage Group

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1-702-650-2151

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Information

Phone:
1-702-650-2151
Fax:
1-702-650-2305
Email:
Click Here
Hours:
Mon-Fri: 8am-5pm (PST)

Rate Quote / Pre-Qualifying Form

Please fill in all required fields and press the "Submit" button, or Print this form and mail or fax it to our office and a loan officer will contact you promptly.

Mail: Countryside Mortgage Group Attn: Mike Mangione
2755 E. Desert Inn Rd. Suite 250
Las Vegas, NV 89121
Fax: 702-650-2305
Phone: 1-800-775-4960 or 702-650-2151 in Las Vegas Metro Area

* - Required Fields

Borrower

First Name*

Last Name*

SS# - -

Address*

City*

State*

Zip*

Email*

Do you Own or Rent? Own Rent

Home Phone (Area Code Included)

Work Phone (Extension if required) ext.

Gross Monthly Income

It's best to call between

and am pm

Phone# to call (Area Code Included)

Loan Purpose

Preferred Loan Type

Desired Loan Amount

Value of Home

Rate your Credit

Comments

**We authorize Countryside Mortgage Group (CSMG Corp) to obtain any and all information and documentation that they request. This information includes, but is not limited to, credit history, employment history, and income and account balance information.

If you are mailing or faxing the form, a Signature is required.
.

______________________________________________________________ Borrower Date Co-Borrower Date