Borrower (Full Name):
Date of Birth:	(ex. dd/mm/yyyy)
Soc. Security #:
Residence Phone #:
Business Phone #:
Present Address:
City:
State/Province:
Zip Code/Postal Code:
E-mail Address
Years at Present Address:		Rent $	/month
	or	Own $

Previous Address:
City:
State/Province:
Zip Code/Postal Code:

Marital Status:	Married Separated Unmarried (including single, divorced, or widowed)

Occupation: (Position & Title)
# of years:
Place of Employment: (Name & Address)
Previous Employer: (Name & Address)

Co-Borrower Information:

Co-Borrower (Full Name):
Date of Birth:	(ex. dd/mm/yyyy)
Soc. Security #:
Residence Phone #:
Business Phone #:
If same as borrowers address
Present Address:
City:
State/Province:
Zip Code/Postal Code:
E-mail Address
Years at Present Address:		Rent $	/month
	or	Own $

If same as borrowers address
Previous Address:
City:
State/Province:
Zip Code/Postal Code:

Marital Status:	Married Separated Unmarried (including single, divorced, or widowed)

Occupation: (Position & Title)
# of years:
Place of Employment: (Name & Address)
Previous Employer: (Name & Address)

Gross Annual Income:

	Borrower	Co-Borrower
Self-Employed ?	Yes No	Yes No
Base Salary:	$	$
Overtime:	$	$
Bonuses:	$	$
Commissions:	$	$
Dividends:	$	$
Net Rental Income:	$	$
Other:	$	$

Total:	$	$

Do You Intend To Occupy This Property ? Yes No
Number of Children:
Ages:
Other Dependents:

Assets:

Checking:	$	Bank:
	$	Bank:
Savings:	$	Bank:
	$	Bank:
Credit Union:	$	Bank:
Stocks:	$
Bonds:	$
Life Insurance:	$

Present Residence (If Owned):
Market Value:	$
Morg. Value:	$
Lender:

Other Assets (Specify):

Liabilities:

(List outstanding obligations including auto loans, mortgage payments,credit cards,
personal loans, and all other loans.)

Type	Creditor's Name	Unpaid Balance	Due Date	Monthly Payment
		$		$
		$		$
		$		$
	Total:	$		$

Additional Monthly Obligations:
Alimony:		$
Child Support:		$
Child Care:		$

Are There Any Judgements or Lawsuits Present?

Yes No

Amount:

Is Any Part of the Down Payment or Settlement Costs
Being Obtained From a Source Other Than From Assets
Listed Above?

Yes No

I hereby give my consent to have my credit report secured
from any credit reporting agency which you designate.

Yes No

We take your privacy seriously.
Your personal information is collected for the purpose of sending you additional information about the real estate, mortgage, and affiliated products and services for which you requested information. If there is a service that we cannot provide for you we may have another agent or broker provide you with applicable information. Should you have any questions as to the collection, use, or disclosure of your personal information, please refer to the real estate marketing website privacy policy.

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