Reason for Loan:
Purchase Refinance Home Improvements
Second Mortgage Lines of Credit Debt Consolidation
Last Name First Name
Date of Birth SSN#
Address City
State Zip How Long
Phone Number Work Number
Co-borrower
Most Recent Employer
How Long
Monthly Income Before Taxes
Position
Value of Home Balance$
Rate%
What is this loan for? Refinance Purchase
First time home buyer? Yes No
How long do you plan to stay in your home or loan? 5 years 10 years 15 years 20 years 25 years 30 years 35 years 40 years
Self Employed? Yes No
How would you assess your credit? Excellent Fair Poor
Check Your Priorities Below:
Lower overall monthly payments
Home improvements
Pay off credit cards
Lower rate and payments
Pay for education
