Purchase: choose one:

Estimate  Purchase Price: $

Estimate  Down Payment: $

Estimated Loan Amount: $

Loan Term:

(Choose One: 30 years fixed, 25, 20, 15, or 10 years Fixed or 5, 7 or 10 ARM)

Borrower A

Borrower B

Name: First, Initial, Last:

Current Address:

(Provide former address if present address is less than two years)

Former Address:

own; rent

No of Years

Social Security Number:

Date of Birth:

Marital Status (Married, Unmarried, Separated)

Home Phone or Cell Phone Number

Email Address:

Number of Dependents & Ages

Employment: Needed 2 years of Employment History, Starting With the Most Current

Company Name:

Company Address:

Job Position/Title:

Total Annual Income: $

Started Date:

Ended Date:

Number of Years in This Line of Business:

Self Employed:

Number of Year(s) in Business:

Please Notice: Self-Employed borrower(s) must be in business for two consecutive years by lender's regulation.

Assets:

-  Checking - Balance:

-  Savings - Balance: