LAST NAME      FIRST NAME

CO-BORROWER:

LAST NAME      FIRST NAME

ADDRESS:

CITY:

STATE:

ZIP:

HOME PHONE NUMBER:

WORK PHONE NUMBER: ext.

EMAIL:

BEST TIME TO CONTACT YOU: MORNING  OR EVENING

YEARS OF RESIDENCE:  

SUBJECT PROPERTY:

ADDRESS:  

CITY:

STATE:

ZIP:  

DATE PURCHASED: mm/dd/yy

PURCHASE PRICE:

ESTIMATED MARKET VALUE:

PROPERTY TYPE:   Single Family Dwelling Manufactured House 2-4 Units Condo Other

OTHER (Please explain)  

OWNER OCCUPIED?:   Yes NO

TYPE OF LOAN:   Purchase Refinance Debt Consolidation Home Improvement

CURRENT BALANCES ON MORTGAGES:

1^ST :  BALANCE -

MONTHLY PAYMENT:  

INTEREST RATE:

2^nd :  BALANCE -

MONTHLY PAYMENT:

INTEREST RATE:

3^RD:  BALANCE  

MONTHLY PAYMENT:  

INTEREST RATE:  

DO YOU PAY PMI?: Yes No

LOAN AMOUNT REQUESTED:

PURPOSE OF LOAN:

HOW DO YOU GRADE YOUR CREDIT?:   A B C D

FORECLOSURE OR BANKRUPTCY IN THE LAST 7 YEARS?: Yes No

CURRENT TAX LIENS OR JUDGEMENTS?: Yes No

GROSS HOUSEHOLD INCOME:

HOUSEHOLD DEBT:  

YEARS WITH CURRENT EMPLOYER?:

SELF-EMPLOYED?: Yes No

COMMENTS: