BORROWER’S INFORMATION
DATE:
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
TIME:
Hour Minutes
AM
PM
AM/PM Option
Borrower’s Name
Address:
Home Phone #:
Format: (000) 000-0000.
Cell #
Format: (000) 000-0000.
Work Phone #:
Format: (000) 000-0000.
Social Security #
Co-Borrowers Name
Address:
Home Phone #:
Format: (000) 000-0000.
Work Phone #:
Format: (000) 000-0000.
Social Security #
REFINANCE /CASH-OUT / PURCHASE / 2ND MORTGAGE
LOAN INFORMATION
1st Mortgage
Balance $
Company:
Interest Rate $
If Adjustable -When does it reset?
Term
Please Select
15
30
40
Year Acquired
Monthly Payment $
Are your Taxes & Insurance included in monthly payment?
Would you like to remain that way?
2nd Mortgage / Credit Line
Balance $
Company:
Interest Rate%
If Adjustable - When does it reset?
Term
Please Select
15
30
40
Year Acquired
Monthly Payment $
Are your Taxes & Insurance included in monthly payment?
Would you like to remain that way?
HOME INFORMATION
Live in home?
If yes, How many years?
Appraised Value $
Original Cost $
Property Taxes $
yearly
Home Owners Insurance $
Schedule of Real Estate Owned:
Other Properties?
EMPLOYMENT / Primary Borrower
Employed?
Position:
At Job:
years
In Industry?
years
Annual Income $
Total Household Income $
Yearly:
Spouse / Co-Borrower
Employed?
Position:
At Job:
years
In Industry?
years
Annual Income $
ASSET BALANCES / DEBTS
Who do you bank with?
Roughly, what is the current balance?
Checking Account $
Savings Account $
Do you have any of the following?
IRA
Stocks
Bonds
CD's
401K
Roughly, How much? $
Subject Property Address:
Would you like to consolidate any credit cards?
How much credit card debt $
Any additional funds for yourself?
Extra Cash-Out - $
PURCHASE ONLY
Years at present address
Renting?
Monthly payment $
Desired Value $
Down Payment %
or $
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