Borrower Information

Borrower

Borrower's Name
(include Jr. or Sr. if applicable)

First

Middle

Last

Suffix

Social Security Number

Home Phone
(incl. area code)

DOB
(mm/dd/yyyy)

Yrs School

Married

Separated

Unmarried
(include single, divorced, widowed)

Dependents
(not listed by Co-Borrower)

No.

Ages

Present Address

Street

City

State

Zip

Own

Rent

No. Yrs.

Mailing Address, if different from Present Address

Street

City

State

Zip

Co-Borrower

Co-Borrower's Name
(include Jr. or Sr. if applicable)

First

Middle

Last

Suffix

Social Security Number

Home Phone
(incl. area code)

DOB
(mm/dd/yyyy)

Yrs School

Married

Separated

Unmarried
(include single, divorced, widowed)

Dependents
(not listed by Borrower)

No.

Ages

Present Address

Street

City

State

Zip

Own

Rent

No. Yrs.

Mailing Address, if different from Present Address

Street

City

State

Zip

If residing at present address for less than two years, complete the following:

Former Address

Street

City

State

Zip

Own

Rent

No. Yrs.

Former Address

Street

City

State

Zip

Own

Rent

No. Yrs.

Employment Information

Borrower

Employer Name

Street

City

State

Zip

Self Employed

Yrs. on this job

Yrs. employed in this line of work/profession

Position/Title/Type of Business

Business Phone
(incl. area code)

Co-Borrower

Employer Name

Street

City

State

Zip

Self Employed

Yrs. on this job

Yrs. employed in this line of work/profession

Position/Title/Type of Business

Business Phone
(incl. area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Employer Name

Street

City

State

Zip

Self Employed

Date From:

Date To:

Position/Title/Type of Business

Business Phone
(incl. area code)

Monthly Income:

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Employer Name

Street

City

State

Zip

Self Employed

Date From:

Date To:

Position/Title/Type of Business

Business Phone
(incl. area code)

Monthly Income:

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Monthly Income and Combined Housing Expense Information

Monthly Income

 

Base Empl. Income

Overtime

Bonuses

Commissions

Dividends⁄Interest

Net Rental Income

Other

 

 

Borrower

 

 

 

Co-Borrower

 

 

 

Combined Mo. Housing Expense

Rent

First Mortgage

Other Financing

Hazard Insurance

Real Estate Taxes

Mort. Insurance

Home Assn. Dues

Other

Present

 

 

Proposed

 

 

 

Assets

Assets

Description

Cash deposit toward purchase held by:

Cash or Market Value

List checking and savings accounts below:

Stocks & BondsSharesTotal

Life insurance net cash value

Face amount:

Vested interest in retirement fund

Net worth of business(es) owned

Automobiles owned

Make & YearValue

Other Assets

DescriptionValue

Name and address of Bank, S&L, or Credit Union

Acct. no.

 

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Schedule of Real Estate Owned:

*Select S if sold, PS if pending sale or R if rental being held for income
Property Address:
*S/PS/RTypeRemarks
Market ValueAmt of MtgGross RentMtg PaymentIns/Tax/MiscNet Rent

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