Customer Information Form

To help us serve you better, please provide your most updated information in the fields below.

Note that items marked with "*" are required to submit the form.

First Name *

Last Name *

Name(s) Listed on Credit Agreement (if different from above)

Apex Bank Account Number (this information is available on your welcome letter)

Prior Loan Servicer

Prior Loan Account Number

Full Mailing Address Line 1 *

Full Mailing Address Line 2 *

Full Collateral Property Address (if same as mailing, enter "same") *

Full Collateral Property Address line 2

Cell Phone Number *

Alternate Cell Phone Number

Home Phone (if applicable)

Primary Email Address *

Alternate Email Address (if applicable)

Current Place of Employment

Work Phone Number

Position Title

Current Place of Employment (coborrower, if applicable)

Work Phone Number (coborrower)

Position Title (coborrower)

Additional contact/relevant information, if applicable:

0/50 characters

Best Number to Contact You *

Are your property taxes escrowed? *

Date taxes next due (MM/YY)

Is your homeowner's insurance escrowed? *

Date insurance next due (MM/YY)

Homeowner's Insurance Company

Insurance company phone number

Are any other items escrowed (ex: HOA dues, PMI, etc.)? *

If yes to the above, what additional items are escrowed?

Do you need someone from our office to contact you? *

If you selected "yes" to the above, please leave a detailed comment of how we will be able to assist you including any questions you have as well as the best number to contact you.

0/500 characters

IMPORTANT NOTICE:

We are unable to release account specific information via email until we have confirmed identifying information with you over the phone.

You may reach us at 1-888-869-2739, ext 2001 during our business hours of 8:00 a.m. to 5:00 p.m. Eastern Time, Monday through Thursday and 8:00 a.m. to 4:30 p.m. on Friday.