On-line Enrollment
   
Take the first steps to saving thousands of dollars!

Please complete and submit this online form.  An Enrollment Specialist will contact you within 48 hours to complete the process and set up drafting dates. Enrollment requires a one time non-refundable fee of $195.00. This fee will be collected over the phone by our Enrollment Specialist.  If you prefer to complete this application over the phone, please call 1-800-251-1315.

All fields required unless indicated as optional.

Primary Information: 

Customer's Name:
(First, Middle, Last)
Date of Birth:
Social Security Number:
(Optional)
 

Secondary Information:

Customer's Name:
(First, Middle, Last)
Date of Birth:
Social Security Number:
(Optional)
 
Property Information:
Property Address:
 
City: State: Zip Code:
 

Contact Information:

Mailing Address:
 
City: State: Zip Code:
Phone Number: Best Time To Call: AM PM (CST)
Fax Number: (Optional) Email Address:
     

Mortgage Information:

Lenders Name:
Lender's Payment Address:
 
City:

State:

Zip Code:
Lender's
Phone Number:		 Loan Number:
Loan Amount: Loan Term: Years
Interest Rate: %    
Payment Due Date: Grace Period: Days
     
First
Payment:		 Regular Monthly Payment:
Which program is preferred:
 
I acknowledge that this form will be sent to Home Mortgage Services with the intention of enrolling in the Biweekly Mortgage Program.  I acknowledge that an Enrollment Specialist will contact me in the next 48 hours to complete the enrollment process and collect a non-refundable charge of $195.00.