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Last Name:

First Name:

Middle Name or Initial:

Date of Birth (DOB):

   

Street Address:

City:

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County:

Zip Code:

 

Phone Number:

( ) - extension

E-mail Address:

Will there be a co-borrower?

Please complete Co-Borrower information below if "Yes".

Co - Last Name:

Co - First Name:

Co - Date of Birth (DOB):

   

Borrower Employment Information

Employer:

Position:

Years Employed:

Gross Pay:

$

 

 

Co - Employer:

Co - Position:

Co - Years Employed:

Co - Gross Pay:

$

 

 

Loan Information

Loan Being Applied to:

Requested Loan Amount:

$

Maximum Loan Payment Desired:

$

Length of Loan Desired:

Have You Found a Home:

Are you obligated to pay alimony, child support, or separate maintenance?

if "Yes" How much: $

Current Assets

Do You Currently Own a Home?

 

 

Is this the same address as stated above?

(if "Yes" leave below address info blank)

 

Street Address:

City:

State:

County:

Zip Code:

 

Purchase Price:

$

Date of Purchase:

   

Current Value:

$

1st Mortgage is:

1st Mortgage Payment:

$

1st Mortgage Rate:

%

1st Mortgage Balance:

$

2nd Mortgage is:

2nd Mortgage Payment:

$

2nd Mortgage Rate:

%

2nd Mortgage Balance:

$

Type of Home:

 

 

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