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Property Information and Purpose of Loan

Subject Property Address
Street
City, State, Zip

Purpose of Loan	Purchase Refinance
Property will be:	Primary Res. Secondary Res. Investment

Borrower's information

Borrower
First Name
Last Name
E-mail
Social Security Number
Home Phone
Work Phone
Age
Current Address
City, State, Zip
Own/Rent
Yrs. at Address

Co-Borrower
First Name
Last Name
Social Security Number
Home Phone
Work Phone
Age
Current Address
City, State, Zip
Own/Rent
Yrs. at Address

Employment Information

Borrower
Employer
Address
City, State, Zip
Yrs. on the job
Position/Title
Type of Business
Business Phone

Co-Borrower
Employer
Address
City, State, Zip
Yrs. on the job
Position/Title
Type of Business
Business Phone

Monthly Income and Combined Housing Expense Information

Monthly Income
Gross Monthly Income	Borrower	Co-Borrower's
Base Empl. Income	$	$
Overtime	$	$
Bonuses	$	$
Commissions	$	$
Dividends/Interest	$	$
Net Rental Income 1	$	$
Net Rental Income 2	$	$
Other	$	$
Total	$	$

Combined Housing Expense
Rent	$
First Mortgage (P&I)	$
Other Financing (P&I)	$
Hazard Insurance	$
Real Estate Taxes	$
Mortgage Insurance	$
Homeowner Asso. Dues.	$
Other	$
Total	$

Assets and Liabilities

Assets

Cash deposit toward purchase held by

Bank Accounts
Name of Bank
Account Number
Cash or Market Value	$

Name of Bank
Account Number
Cash or Market Value	$

Name of Bank
Account Number
Cash or Market Value	$

Name of Bank
Account Number
Cash or Market Value	$

Retirement Savings Plan
Company Name
Description
	$

Company Name
Description
	$

Life Insurance net cash value
Company Name
Face Value	$	Cash Value	$

Liabilities
Company Name
Monthly Balance	$

Company Name
Monthly Balance	$

Company Name
Monthly Balance	$

Company Name
Monthly Balance	$

Company Name
Monthly Balance	$

Company Name
Monthly Balance	$

Company Name
Monthly Balance	$

Alimony/Child Support/Separate Maintenance Payments Owed
Owed To:				$

Job Related Expense (child care, union dues, etc.)				$

DECLARATIONS


	Borrower		Co-Borrower
	Yes	No	Yes	No
(a) Are there any outstanding judgments against you?	_		_

(b) Have you been declared bankrupt within the past 7 years?	_		_

(c) Have you had property foreclosed upon or given title or deed in lieu therof 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 three 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)?