Referred by	Realtor
	Friend
	Web Search
	Other
Borrower Name
Social Security
Address
City State Zip Code
Work Ph. Home Ph. Email Addr.
Present Employer Start Date
If Less then 2 Years with Present Employer
Previous Employer Start Date End Date

Co-Borrower Name
Social Security
Address
City State Zip Code
Work Ph. Home Ph. Email Addr.
Present Employer Start Date
If Less then 2 Years with Present Employer
Previous Employer Start Date End Date

	Borrower	Co-Borrower
Self-Employed	Yes No	Yes No
Gross Monthly Income	$	$
Other Income (Interest,Div.,Etc.)	$	$

Loan Amount Request	$ Purchase Refinance
You Presently :	Own Rent
Mortgage or Rental Payment	$
Liabilities:
Monthly Installment Payments	$ / month
	(Car, Student Loan, Child Support, Etc.)
Min. Monthly Revolving Payments	$ / month

Assets
Checking/Savings	$		401K, IRA	$
Stocks/Bonds	$		Cash Gifts	$

	Borrower	Co-Borrower
Do you have outstanding judgments against you?	Yes No	Yes No
Did you declare bankruptcy in the past 7 years?	Yes No	Yes No
Have you had a foreclosure in the past 7 years?	Yes No	Yes No
Are you a party to any lawsuit?	Yes No	Yes No
Are you delinquent on any federal debts?	Yes No	Yes No
Are you obligated to pay child support?	Yes No	Yes No
Are you a co-signor on someone else's loan?	Yes No	Yes No
Are you a U.S. citizen?	Yes No	Yes No
Are you a permanent resident alien?	Yes No	Yes No
Will you occupy the property as primary residence?	Yes No	Yes No

Comments/Questions