Loan Information


Loan Amount
 Purchase Price/Appr. Value
 Purpose
Purchase
Refinance 		Property Type
Primary Residence
Second Home
Investment


Borrowers Information

Contact email address


Borrower Co-Borrower
Borrower's
Last Name

S.S.Number

Present Address

City

State

Zip Code

 First Name,
Middle Ini.

Phone Number

Rent   Own  
Number of Years

Married  
Unmarried   		Co-Borrower's
Last Name

S.S.Number

Present Address

City

State

Zip Code

 First Name,
Middle Ini.

Phone Number

Rent   Own  
Number of Years

Married  
Unmarried  


Employment Information


Borrower Co-Borrower
Employer Name

Street

City

State

 Self Employed
Phone No.

Years on Job

Years in
Profession

 Employer Name

Street

City

State

 Self Employed
Phone No.

Years on Job

Years in
Profession


Monthly Income and Housing Expense

Gross Monthly Income Borrower Co-Borrower Monthly Housing Expense
Base Income Rent
Overtime First Mortgage (P&I)
Bonuses Second Mortgage (P&I)
Commissions Hazard Insurance
Dividends/Interest Property Taxes
Rental Income Mortgage Insurance
Other Homeowner Assn. Dues


Assets and Liabilities
Assets Current Value Liabilities Monthly Payment


Institution Name
Name
Institution Name
Name
Institution Name
Name
Institution Name
Name
Institution Name
Name
Stocks & Bonds
Name

Real Estate
Name


Declarations


If you answer yes to any questions a through i, please furnish explanations to your loan consultant Borrower Co-Borrower
  Yes No Yes No
a: Are there any outstanding judgements against you?
b. Have you been declared bankrupt within the past seven years?
c. Have you had property foreclosed upon in the last seven years?
d. Are you a party to a lawsuit?
e. Have yo udirectly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (This would include such loans as home mortgage laons, SBA loans, home improvement loans, educational loans, manufactured (mobile)home loans, any mortgage, financial obligation, bond or loan guarantee. If "Yes,"provide details, including date, name and address of lender
f. Are you presently delinquent or in default on any Federal debtor any other loan, mortgage, financial obligation, bond or loan guarantee?
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence? If "Yes," complete question m. below
m. Have you had an ownership interest in a property in the last three years?

(1) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP) (PR) 
(SH) 
(IP) 
 (PR) 
(SH) 
(IP) 
(2) How did you hold title to the home-soley by yourself (S), jointly with your spouse (SP), or jointly with another person (O) (S) 
(SP) 
(O) 
 (S) 
(SP) 
(O)