*Borrower Name:

Social Security Number:

*Home Phone Number:

*Work Phone Number:

*E-Mail Address:

Cellular Phone Number:

*Monthly Income: $

*Best Time to Call: Morning Afternoon Evening

*Best Place to Call: Home Work Cell

*Subject Property Address:

*City:

*State:

*Zip Code:

*Property Type: Single Family Residence Multi Family Residence Cond 2-4 Units

*Occupancy Type: Owner Occupied Non Owner Occupied Investment

*Purchase Amount: $

*Estimated Property Value: $

*Loan Type Requested: 1st 2nd Equity

*Purpose of Loan: Shorter Term Debt Consolidation Cash out Lower payment

*Loan Amount Requested: $

*Existing 1st Mortgage Amount: $

Existing 2nd Mortgage Amount: $

Amount of Other Liens: $

*Total Monthly Mortgage Payments: $

*Total Monthly Credit Card Payments: $


Co-Borrower Name:

Co-Borrower Social Security Number:

Co-Borrower Monthly Income: $