Borrower
Name:  
E-mail: 
See Privacy Policy at left
Home Phone:            
Work or Cell Phone: 
Best time to contact:      Morning Afternoon Evening Anytime
Address:
City:        
State:      Zip:
Do you: Rent Own How long?
Monthly Payment:
How long on job? 
Gross Monthly Income: (before taxes) Salary:
Other: 
Are you a US Citizen? Yes No
Ever filed Bankruptcy? Yes No
If yes, what month?
If yes, what year?   
Social Security Number
By Initialing below, I hereby authorize a Credit Report to be obtained from a Credit Reporting Agency.
Your Initials:

When do you plan to buy a house? now 30 to 60 days 60 to 90 days more than 90 days   
What is the property for? Primary Residence Second Home Investment Property
Approximate Loan Amount Desired:
Cash Available at closing time:
Checking Account:           
Savings Account:              
Stocks/Bonds:                  
Retirement Account:         
Equity in home to be sold:

Current Monthly Payments
Credit Cards:                   
Car Loan:                         
Student Loans:                
Other Loans:                    
Child Support / Alimony: 

Co-Borrower (if applicable)
Name:  
If there is no CoBorrower, scroll down
E-mail: 
Home Phone:            
Work or Cell Phone: 
Best time to contact:      Morning Afternoon Evening Anytime
Address:
City:        
State:      Zip:
Do you: Rent Own How long?
Monthly Payment:
How long on job? 
Gross Monthly Income: (before taxes) Salary:
Other: 
Are you a US Citizen? Yes No
Ever filed Bankruptcy? Yes No
If yes, what month?
If yes, what year?   
Social Security Number
By Initialing below, I hereby authorize a Credit Report to be obtained from a Credit Reporting Agency.
Your Initials:

Enter any additional comments or questions here:



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