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APPLICATION DATE HOME PHONE
E-MAIL ADDRESS
NAME: SS# DOB
NAME: SS# DOB
PRESENT ADDRESS
MORT.INTEREST- REFINANCE PURCHASE RESIDENTIAL COMMERCIAL
PROPERTY ADDRESS
DATE PURCHASED PURCHASE PRICE
ESTIMATED CURRENT VALUE
DOWNPAYMENT- YES NO SOURCE OF DOWNPAYMENT
PROPERTY TYPE- PRIMARY SECONDARY RENTAL OTHER
FOUNDATION- SLAB PIERS EXTERIOR BRICK WOOD SIDING
HEATING/COOLING- CENTRAL WINDOW UNITS SPACE HEATERS
PRESENT EMPLOYER YEARS ON JOB
TYPE OF BUSINESS POSITION
EMPLOYER PHONE GROSS MONTHLY INCOME
PRESENT EMPLOYER YEARS ON JOB
TYPE OF BUSINESS POSITION
EMPLOYER PHONE GROSS MONTHLY INCOME
IS YOUR CURRENT MORTGAGE A BOND FOR DEED? YES NO
CURRENT MORTGAGE HOLDER AMOUNT
TYPE OF MORTGAGE - FIXED ADJUSTABLE BALLOON TERM- 15 30
CURRENT INTEREST RATE % DO YOU HAVE A 2ND MORTGAGE YES NO
HAS YOUR MORTGAGE BEEN OVER 30 DAYS LATE IN THE LAST 12 MONTHS? YES NO
HAVE YOU FILED BANKRUPTCY IN THE LAST 10 YEARS? YES NO
IF SO, WHAT TYPE- 7 11 13 DATE DISCHARGED-
TO YOUR KNOWLEDGE, ARE THERE ANY JUDGMENTS AGAINST YOU? YES NO
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