Name(s):

Phone:

Mailing Address:

Physical Address:

Years at this Address:

Type- (Condo, Home,Etc):

Own Other Property?:

If Yes, # of Properties:

Borrower Employer Name:

Years Employed

Borrower Income:

CoBorrower Employer Name:

Years Employed

CoBorrower Income:

Liquid Assets:

Borrower's Credit:

CoBorrower's Credit:

Permission to Pull Credit:

Borrowers SSN:

CoBorrowers SSN:

Borrowers DOB

CoBorrowers DOB

Estimated Value:

Original Cost:

Amount Owed (1st):

2nd Mortgage Balance:

Current Payment (1st):

2nd Mortgage Payment:

Current Interest Rate (1st):

2nd Mortgage Rate:

Do You Have Mortgage Insurance?:

If Yes, MI Payment (Monthly):

Home Owner's Insurance Co.:

Agent:

Premium:

Due Date:

Annual Property Tax Amount:

Sales Price:

Type- (Condo, Home, Etc):

Down Payment:

Source- (Own Assets, Gifted, Etc.):

Preferred:

Phone

Best Time: