BORROWER INFORMATION
       
Borrower Co-Borrower
First Name:   First Name:  
Last Name:   Last Name:  
Social Security No:   Social Security No:  
Contact Phone:   Home Phone:  
E-Mail Address:   E-Mail Address:  
Borrower's Present Address

Co-Borrowers Present Address
How many years at current address?
How many years at current address?
Street Address Street Address
City St Zip Code City St Zip Code
 
Employment and Income Information
Company Name Company Name
Street Address Street Address
Business Telephone Number Business Telephone Number
Position Held
Position Held
Years on Job
Years on Job:
 

Gross Monthly Income

 Borrower Co-Borrower
  Base Employment Income  
  Overtime  
  Bonus  
  Commissions  
  Net Rental Income  
  Total  
  Assets   Balance Balance
  Checking Account(s)  
  Savings Account(s)  
Liabilities Monthly Payment Balance Due
  Monthly Credit Card(s) Debt  
  Total Monthly Automobile Loan(s)  
  Other  
  Total  
      Borrower Co-Borrower
Have you owned a home that was your primary residence in the last 3 years?   Yes No Yes No
Are there any outstanding judgments against you?   Yes No Yes No
Have you been declared bankrupt in the past 7 years?   Yes No Yes No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?   Yes No Yes No
Are you obligated to pay alimony, child support, or separate maintenance?   Yes No Yes No
Please select which down payment percentage you would prefer.    0-3% 5-10% 10-20% 20%+
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