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Borrower Information Section
Borrower First Name
Borrower M.I.
Borrower Last Name
Borrower Title
Borrower Birthdate
Home Phone - -
Work Phone - -
Email Address
Current Address
Do you?
How Many Years?
Co-Borrower First Name
Co-Borrower M.I.
Co-Borrower Last Name
Co-Borrower Title
Co-Borrower Birthdate
Contact Notes
Loan Information Section
Loan Purpose
I would like to purchase a home and do not have an accepted contract
I am purchasing a home and have an accepted contract with a seller
I would like to reduce the interest rate, change loan type or term or consolidate the existing loans(s) on my home
I would like to refinance my current balance and take cash out with this loan
I would like to obtain a second mortgage or equity line on my home
Target Rate
Loan Program
Purchase Price
Down Payment
Refinance Information Section
Amount of Non-Mortgage debt to be paid off
1st Mortgage Balance
1st Mortgage Rate
1st Mortgage Payment
2nd Mortgage Balance
2nd Mortgage Rate
2nd Mortgage Payment
Additional Cash Desired
Mortgage Notes
Property Information Section
Property Value
Property Type
Income Information Section
Notice Alimony, child support and separate maintenance income need not be revealed if you choose not to have it considered.
Borrower - Number of Years on the Job
Borrower - Income Type
Borrower - Gross Monthly Income
Co-Borrower - Number of Years on the Job
Co-Borrower - Income Type
Co-Borrower - Gross Monthly Income
Other - Number of Years on the Job
Other - Income Type
Other - Gross Monthly Income
Can all borrowers verify income?
Income Notes
Asset Information Section
Liquid Assets
Real Estate Net Proceeds
Gift Money
Stocks & Bonds
Credit Information Section
Borrower - Social Security Number - -
Co-Borrower - Social Security Number - -
Tell us a little about your credit history?
May we access your credit report to help determine your qualifications for a loan?
Total Monthly Debt
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