Please
complete the following information as completely and
accurately as possible
Borrower
Information
Primary
Applicant First Name: *
Primary
Applicant Last Name: *
Applicants SSN #:
Optional
xxxxxxxxx
Street
Address: *
City:
*
State: *
Zip
Code: *
How many years at current Residence
*
Own the home?
Yes
No
Live Rent Free
Home
Phone: *
xxxxxxxxxx
Cell
Phone:
Work
Phone:
Ext:
Current
Email Address: *
How
would you rate your Credit? *
Approx.
Total Monthly Debt:
*
$
ex.500.00
Have
you filed Bankruptcy in the last 7 Yrs?
*
Yes
No
Have
you had a Foreclosure in the last 7 Yrs?
*
Yes
No
Do you pay child
support or alimony?*
Yes
No
Name of Current Employer:
Gross
Monthly Income: *
$
ex.5,000.00
Years
with Current Employer: *
Are you
self Employed?:
Yes
No
Co-Borrower
Information
Co-Borrower's First Name:
Co-Borrower Last Name:
Co-Borrower SSN #:
Optional
xxxxxxxxx
Street
Address:
City:
State:
Zip
Code:
How many years at current
Residence:
Own the home?
Yes
No
Live Rent Free
Home
Phone:
xxxxxxxxxx
Cell
Phone:
Work
Phone:
Ext:
Current
Email Address:
How
would you rate your Credit?
Have
you filed Bankruptcy in the last 7 Yrs?
Yes
No
Have
you had a Foreclosure in the last 7 Yrs?
Yes
No
Do you pay child
support or alimony?
Yes
No
Name of Current Employer:
Gross
Monthly Income:
$
ex.5,000.00
Years
with Current Employer:
Are you
self Employed?:
Yes
No
Purchase
Information
Are
you working with a Realtor?
Yes
No
If Yes,
what is the Realtors Name?
Do
you a home picked out?
Yes
No
What
County will the Property be located?
Property
Type? *
Property Use?
*
Estimated
purchase price? *
$
Desired
new loan amount? *
$
Refinance Information
In what
Year was your property built?
What County will the Property be located?
Property
Type?
*
Property Use?
*
Estimated
Current Value? *
$
Desired
new loan amount? *
$
Who do you
pay for the 1st mortgage?
What is
the balance of the 1st mortgage?
What is
current rate on the 1st mortgage?
If you
have a 2nd mortgage, list balance:
What is
the 2nd mortgage rate?
Contact
Information
Best
Time To Contact You:
Special
Notes:
Limit 150 Characters
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