Please enter the name of the Broker you are working with:

Property Information____________________________________________________ 

Property Address

Number of Units      Year house was built

 Purpose of Loan Purchase Refinance Construction Construct-Perm  Property will be Primary Residence Secondary Residence Investment

Title will be held in what names?

Manner held? Community property Joint tenants JTWROS Single man Single woman Tenants in common Determined in escrow Unmarried man Unmarried woman Estate will be held in? Fee Simple Leasehold

Borrower Information____________________________________________________

Borrower Name: (First) (Initial) (Last)

Social Security# Age    Date of Birth  (MM/DD/YY)

Yrs School Completed              Home Phone  

Marital Status Married Separated Unmarried No. of Children   Ages  

Present Address (Previous Address if less than 2 years total)                              Own/Rent    No. Yrs.      Own Rent        Own Rent        Own Rent   

 Employment Self Employed Employed Retired DisabledName of Employer  

Employer Address Yrs on job  2 Years Needed

Years in this line of work Job Title Phone  

If less than 2 yrs at current employment,  please complete the following previous employment fields.

Prev. Employer Frm/To 

Addr Job Title  

Monthly Income    Phone   

If less than two years with previous employer complete the following

Prev. Employer Frm/To 

Addr Job Title  

Monthly Income    Phone   

Co-Borrower Information________________________________________________

Co-Borrower Name: (First) (Initial) (Last)

Social Security# Age   Date of Birth  (MM/DD/YY)

Yrs School Completed     Home Phone  

Marital Status Married Separated Unmarried    No. of Children    Ages  

Present Address (Previous Address if less than 2 years total)                               Own/Rent  No. Yrs.      Own Rent       Own Rent       Own Rent  

 Employment Self Employed Employed Retired DisabledName of Employer  

Employer Addr Yrs on job  2 Yrs Needed

Yrs in this line of work Job Title Phone  

If less than 2 yrs at current employment,  please complete the following previous employment fields.

Prev. Employer Frm/To 

Addr Job Title  

Monthly Income    Phone   

If less than two years with previous employer complete the following

Prev. Employer Frm/To 

Addr Job Title  

Monthly Income    Phone   

 Monthly Income and Combined Housing Expense Information__________________

Gross Monthly Incomes for Borrower and Co Borrower

Base Employment Income ------------- Borrower $ Co-Borrower $

Overtime (Consistent each month) - Borrower $  Co Borrower $

Bonuses (Consistent each month) -- Borrower $  Co Borrower $

Commissions ----------------------------- Borrower $ Co Borrower $

Dividends/Interest ---------------------- Borrower $ Co Borrower $

Net Rental Income ---------------------- Borrower $ Co Borrower $

Combined Monthly Housing Expense

Rent-$   or   First Mortgage (Principle & Interest) -$

Second Mortgage (Principle & Interest)-$  Hazard (Homeowners) Insurance - $

Real Estate Taxes (Monthly Amt) - $   Mortgage Insurance (If Applicable) - $  

Monthly Homeowners Assn. Dues - $

Assets and Liabilities (Borrower and Co-Borrower)__________________________

ASSETS

 Name & Address Of Bank                                                                 Account Number           Approx. Bal                              

Stocks & Bonds (Company Name, Number & Description)                                                           Amount      

Life Insurance  Cash Value - Face Amount $ Vested Interest in Retirement Fund $

Net Worth of Business(es) Owned $ Real Estate Owned (Totl Mkt Value) $

Autos/Boats Owned (Make & Yr)    Retail Value          Autos/Boats Owned (Make & Yr)     Retail Value                                                      

Replacement Value of Household Goods (Furniture, TV's, Jewelry, Art, etc.) - $10,000 $15,000 $20,000 $30,000 $40,000 $50000 $60,000

LIABILITIES

Name and Account#  of Company                                                                                Mthly Pymt     Unpd Bal.                                   

Schedule Of Real Estate Owned___________________________________________

Property                                                                       Type            Market             Mtg        Grs Rntl        Mtg      Ins/Tax   Address                                                                       Prop.            Value          Amount        Income      Pymnt      Pymnt  Sfr 2-4Plx Condo Town Mobile Sfr 2-4Plx Condo Town Mobile Sfr 2-4Plx Condo Town Mobile Sfr 2-4Plx Condo Town Mobile

If any additional information is required, please enter phone number and best time to call either during the day or evening hour.  Thank you.

Home Phone Work Phone  Fax Number

Cell Phone      Best time to contact?  Day   Evening

How would your rate your credit? Excellent Good Good - Some Lates Some Credit Problems Major Credit Problems Prior Bankruptcys

E-mail address?     Authorization to Pull Credit Reports No Yes