Loan Info

Type of Loan: Purchase Refinance Equity Line Property Type: Primary Residence Rental Close of escrow date (If purchase): Purchase price: $ Down payment: $ Loan amount: $

Property Address

Street: City: State: Zip:

Current Loans (if applicable)

Estimated property value: $ Loan ammount: $ Monthly payment: $ Second mortage: Yes No 2nd Loan ammount: $ 2nd Monthly payment: $

Personnal Info

Borrower Co-Borrower First name: Middle name: Last name:   Evening Phone (required): Day Phone (required): Email address:   Street address: City: State: Zip:   Rent or own: Rent Own Rent Own # of years:   Current employer: Years employed in current job: Monthly gross income:   Other income: Yes No Yes No Other income amount:   Self employed: Yes No Yes No   Total monthly payments on debts (not including current mortgage):

Declarations

If YES, check the box and explain. Borrower Co-Borrower Do you have any outstanding judgments? Yes Yes Have you ever filed for bankruptcy or had a debt adjustment plan confirmed under chapter 11? Yes Yes Have you had property foreclosed upon or repossessed in the last seven years? Yes Yes Are you a party in a lawsuit? Yes Yes Are you other than a U.S. citizen or permanent resident alien? Yes Yes Is your income likely to decline in the next two years? Yes Yes Are you a Co-maker, co-signer or guarantor on any loan above? Yes Yes