Borrower Contact Information

First Name

Last Name

Home Phone

Cell/Mobile

Fax

Email Address

Contact Preference: Pick One Phone Email

Best Time: Pick One 8:00am - 10:00am 10:00am - 12:00pm 12:00pm - 2:00pm 2:00pm - 4:00pm 4:00pm - 6:00pm 6:00pm - 8:00pm

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Primary Borrower Details

Marital Status Pick One Married / Registered Domestic Partners Unmarried / Single / Divorced / Widowed Separated

Date of Birth

Social Security Number

Do you (the borrower) currently rent or own? Pick One Own Rent

How long have you (the primary borrower) lived at present address? Pick One <1 Year 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20+ Years

Primary borrower has dependents

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Loan Details

Loan Purpose Pick One Purchase Property Refinance Property Other

Please Explain

Property will be used as a... Pick One Primary Residence Secondary Residence Investment Property

Purchase Price ($)

Loan Amount ($)

What type of mortgage are you applying for? Pick One FHA 10-30 Conventional VA USDA/Rural Housing Other

Please Explain

Source of down payment

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Primary Borrower Employment Information

Are you (the primary borrower) self-employed? Pick One Yes No

Position/Job Title

Name of Employer

Employer Address

Employer City

Employer State Pick One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Employer Zip Code

Employer Phone

Years on this job? Pick One <1 Year 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20+ Years

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Primary Borrower Income & Credit

Base Monthly Income ℹ ($)

Average Monthly Overtime ($)

Average Monthly Bonuses ($)

Average Monthly Commissions ($)

Declarations

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