Borrower Information
Borrower Name:
 Social Security#:
 Date of Birth: (mm/dd/yy)
Street Address:
City:
 State:
 Zip:
How long have you been at the above address?
Do you own or rent this property?
If less than 2 years at above address, please input your previous address and how long you live there:
Home Phone Number:
 Work Phone Number:
Race/National Origin :
 If other, please specify:
E-mail Address:
 Marital Status:
 Years of School:
 
Co-Borrower Information
Co-Borrower Name:
 Social Security#:
 Date of Birth: (mm/dd/yy)
Street Address:
City:
 State:
 Zip:
How long have you been at the above address?
Do you own or rent this property?
If less than 2 years at above address, please input your previous address and how long you live there:
Home Phone Number:
 Work Phone Number:
Race/National Origin :
 If other, please specify:
E-mail Address:
 Marital Status:
 Years of School:
 
Borrower Employment Information
Company Name:
 Company Address:
Job Title:
 Dates of Employment:(mm/dd/yy)
to present
Annual Salary:
If less than 2 yrs in current position, please list the following info from your previous employer:
Company Name:
 Title:
Dates of Employment:(mm/dd/yy) to
Income:
$		 Type of business:
Address of previous company:
Co-Borrower Employment Information
Company Name:
 Company Address:
Job Title:
 Dates of Employment:(mm/dd/yy)
to present
Annual Salary:
If less than 2 yrs in current position, please list the following info from your previous employer:
Company Name:
 Title:
Dates of Employment:(mm/dd/yy) to
Income:
$		 Type of business:
Address of previous company:
Monthly Income and Combined Housing Expense Information

Gross Monthly Income
Borrower
Co-
Borrower
Total
Combined
Monthly
Housing
Expense
Present
Base Employment Income*
 $ $ $
Rent
 $
Overtime
 $ $ $
1st Mort. (P & l)
 $
Bonuses
 $ $ $
Other Financing
 $
Commissions
 $ $ $
Hazard Insurance
 $
Dividends/Interest
 $ $ $
Real Estate Taxes
 $
Net Rental Income
 $ $ $
Mortgage Insurance
 $
Other
 $ $ $
Other
 $
TOTAL
 $ $ $
TOTAL
 $

*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income Notice: Alimony, Child Support, or separate maintenance income need to be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C  
Monthly Amount
Assets and Liabilities
This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If spouse completed the Co-Borrower section, this Statement and supporting schedules must be completed about that spouse also.

Assets
Cash or Market Value
List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Stocks & Bonds (Company name/number & Description)
 		 
  
Life Insurance net cash value
Face amount: $ 		$
Subtotal Liquid Assets $
Real Estate owned (enter market value from schedule of real estate owned) $
Vested interest in retirement fund $
Net worth of business(es) owned (attach financial statement) $
Automotive owned (make and year)
 		 
  $
Other Assets (itemized)
 		 
  $
Total Assets a. $


Schedule of Real Estate Owned
Property Address
Type
Present
Market
Value
Amount of Mortgage & Liens
Gross
Rental
Income
Mortgage
Payments
Insurance,
Maintenance,
Taxes & Misc.
Net Rental Income
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
VII. DECLARTIONS
  Borrower Co-Borrower
a. Are there any outstanding judgments against you? Y  N Y  N
b. Have you been declared bankrupt within the past 7 years? Y  N Y  N
c. Have you had properly foreclosed upon or given title or deed in lieu thereof in the last 7 years? Y  N Y  N
d. Are you a party to a lawsuit? Y  N Y  N
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? Y  N Y  N
f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage financial obligation, bond, or loan, guaranteed? Y  N Y  N
g. Are you obligated to pay alimony, child support, or separate maintenance? Y  N Y  N
h. Is any part of the down payment borrowed? Y  N Y  N
i. Are you a co-maker or endorser on a note? Y  N Y  N
j. Are you a US citizen? Y  N Y  N
k. Are you a permanent resident alien? Y  N Y  N
l. Do you intend to occupy the property as your primary residence? Y  N Y  N
m. Have you had ownership interest in a property in the last three years? Y  N Y  N
(1) What type of property did you own - principle residence (PR), second home (SH), or investment property (IP)?
(2) How did you hold the title to the home - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?



I authorize this company to do an in-file credit report for pre-qualification

Who were you referred by?