Tell us About Yourself
Borrower:
First name
Last name
Title
Employer
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail
S. S. Number
Date of Birth
Gross Annual Income
Employment and How Long
Co-Borrower:
First name
Last name
Title
Employer
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail
S. S. Number
Date of Birth
Gross Annual Income
Employment and How Long
Tell us about your new home or loan needs
Address
City/State/Zip
Amount of Loan
Is this residence your primary home	Yes No
This application would be for a	Purchase Refinance
Value or purchase price
Amount of Monthly Expenses:
Car Loan/s
Credit Cards
Other Monthly payments
How is your credit?	Excellent Good Fair Poor
Are you current on your existing indebtedness?	Yes No
Do you have outstanding liens or judgements?	No Yes
May we run a preliminary credit check?	Yes No