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I. Loan Amount

II. Property Information & Purpose of Loan
Subject Property Street Address

City

 State
 Zip Code
 No. of Units
Purpose of Loan
 		If other explain: 
 		Year Built
III. Borrower Information
Borrower Co-Borrower
First Name First Name
Middle Name Middle Name
Last Name Last Name
Suffix (Jr., Sr, III) Suffix (Jr., Sr, III)

Social Security #

 Social Security #
Birth Date (m/d/y)
 		Birth Date (m/d/y)
Email Address Email Address
   

Current Home Street Address

Current Home Street Address
City
 		State
Zip
 City
 		State
 		Zip
Own  Rent  |  Number of Years at address: Own  Rent  |  Number of Years at address:
Home Phone (incl. area code)
 		Age
 		Yrs. School
 		Home Phone (incl. area code)
 		Age
 		Yrs. School
Marital Status
 		Dependents
(not listed by Co- Borrower)
No.   Ages 		Marital Status
 		Dependents
(not listed by Co- Borrower)
No.   Ages
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, Zip Code) 
Own  Rent  |  Number of Years at address:

Former Address (street, city, state, Zip Code)
Own  Rent  |  Number of Years at address:

Former Address (street, city, state, ZIP)

  Own  Rent  |  Number of Years at address:
Former Address (street, city, state, ZIP)

Own  Rent  |  Number of Years at address:
 
IV. Employment Information
Borrower Co-Borrower
Name and Address of Employer  
Self Employed
Name of Employer

Address of Employer
 Yrs. on this job
 		Name and Address of Employer 
Self Employed
Name of Employer

Address of Employer
 Yrs. on this job
Yrs. employed in this line of work/profession Yrs. employed in this line of work/profession
Position/Title/Type of Business
 Business Phone (incl. area code)
 Position/Title/Type of Business
 Business Phone (incl. area code)
V. Monthly Income and Combined Housing Expense Information
Gross Monthly Income Borrower Co-Borrower Total Combined Monthly Housing Expense Present Proposed
Base Empl. Income Rent
Overtime First Mortgage (P&I)
Bonuses Other Financing (P&I)
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxes
Net Rental Income Mortgage Insurance
Other (before complete, see the notice in "describe other income", below) Homeowner Assn. Dues
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 not be revealed if the Borrower(B) or Co-Borrower(C) does not choose to have it considered for repaying this loan.
B/C Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co-Borrower(C) does not choose to have it considered for repaying this loan. Monthly Amount
1. 
2. 
3. 
VI. Assets & Liabilities
Description Cash or Market Value
Cash deposit toward purchase held by: 
List checking and savings accounts below
Name & Address of Bank, S&L, or Credit Union
 Acct. no.
Name & Address of Bank, S&L, or Credit Union
 Acct. no.
Name & Address of Bank, S&L, or Credit Union
 Acct. no.
Name & Address of Bank, S&L, or Credit Union
 Acct. no.
Stocks & Bonds (Company name/ number & description)
 Acct. no.
Life insurance net cash value
 Face amount
Subtotal Liquid Assets
Real Estate Owned (enter market value from schedule or real estate owned)
Vested interest in retirement fund
Net worth of business(s) owned (attach financial statement)
Automobiles owned (make and year)
Other Assets (itemize)
Total Assets
VIII. Declarations
If you answer "yes" to any questions A through I, please explain in Comments Box Below Borrower Co-Borrower
a. Are there any outstanding judgments against you?
b. Have you been declared bankruptcy within the past 7 years?
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, 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, FHA or VA case number, if any, and reasons for the action .)
f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee? If "Yes," give details as described in the preceding question.
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 3 years?
(1) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?
(2) How did you hold title to the home? Solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

CREDIT SCORE

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