1. Loan amount requested:      $.00

  2. Cash out desired at closing: $.00

  3. Describe your credit

  Excellent   Good with some problems   Poor with many problems

 

Primary Borrower Information

  1. First:                        Middle:                 Last:                                  Suffix:

                              

  2. What is your Citizenship Status?

 

  3. Marital Status:

 Single  Married   Divorced    Separated

  4. Contact Numbers:

      Home Phone Number:

     

      Work or Cell Phone Number:

     

    Best to contact you at:

  Home  Work   Cell Phone (Check all that apply)

   5. E-mail Address:

  

  6. Please Enter Your Property Address:

  Street:       County:

  City:           Zip:      

  State:  

  Time at Residence:

  Do You Own or Rent at Your Current Address?

Primary Residence Information

   1. What Type of Home is this?

  

   2. How Much do you Estimate the Home to be Worth?

   $.00

   3. What Year did you Purchase this Property?

    

   4. How much did you Pay for this Property?

    $.00

   5. What is the Current First Mortgage Balance on this Property?

    $.00

   6. What is the Monthly Mortgage Payment on this Property?

    $.00

   9. If applicable, what are your Homeowner's or Condominium Association Dues?

    $.00 

  10. What is the Balance on your Second Mortgage Loan or Line of Credit? (if applicable)

    $.00

  11. What is the Monthly Payment on your Second Mortgage Loan or Line of Credit ? (if applicable)

    $.00

 

   Primary Borrower Employment Information

  1. Do you own 25% or more of a business?

   Yes   No

  2. What is your Employment Status?

    

  3. Who is your Current Employer?

   

  4. What is your Title or Position?

    

  5. What is your Business Phone Number?

   

  6. How long have your Worked for your Current Employer?

   

  7. Who was your Previous Employer (if fewer than 2 years at current job)?

   

   8. What was your Previous Title or Position? (if applicable)

   

   9. How long did you work for your Previous Employer? (if applicable)

     

   10. What is your Gross Monthly Salary?

   $.00

    11. What is your Total Monthly other Income?

   $.00

    12. What is the Source of your other Income?

    

    13. Have you ever Declared Bankruptcy?

     Yes    No

    14. Have you ever had a Property Foreclosed upon?

     Yes    No

   15. Do you have any Additional Comments that you would to add?

     

Co-Borrower Information

   1. Please enter the Co-Borrower's full Name:

   First:                                   Middle:            Last:                                      Suffix:

                

   2. What is your Citizenship Status?

  

   3. Contact Numbers:

      Home Phone Number:

     

      Work or Cell Phone Number:

     

    Best to contact you at:

     Home  Work   Cell Phone (Check all that apply)

   4. Do you own 25% or more of a business?

   Yes   No

   5. What is your Employment Status?

    

   6. Who is your Current Employer?

   

   7. What is your Title or Position?

    

   8. What is your Business Phone Number?

   

   9. How long have your Worked for your Current Employer?

   

   10. Who was your Previous Employer (if less than 2 years at current job)?

   

    11. What was your Previous Title or Position? (if applicable)

   

    12. How long did you work for your Previous Employer? (if applicable)

     

    13. What is your Gross Monthly Salary?

   $.00

    14. What is your Total Monthly other Income?

   $.00

    15. What is the Source of your other Income?

    

    16. Have you ever Declared Bankruptcy?

     Yes    No

    17. Have you ever had a Property Foreclosed upon?

     Yes    No

    16. Do you have any Additional Comments that you would to add?