Personal Information

Name:                     

Address:                  

Apt#:                     

City:                     

State:                    

Zip:                      

Home phone:               

Work phone:               

E-mail Address:       

Marital Status

Single

Married

Other

Spouse/Co-borrower's name: 

Number Dependants:        

Cash available for down payment and closing costs: 

Name of Employer:         

Phone:                    

Title:                    

Length of employment in this position:    

Length of time in this profession:        

Present salary per month-(before taxes):  

Spouse/Co-borrower's employer:  

Phone:                    

Title:                    

Length of employment in this position:    

Length of time in this profession:        

Present salary per month-(before taxes):  

Cash/Deposits:             

Stocks & Bonds:            

Life Insurance Cash Value: 

Real Estate Owned:         

Make..............................Year...............Model..............

Other Assets (specify)

Lender..................................Balance........................Monthly Payment

Auto Loans

Lender..................................Balance........................Monthly Payment

Credit Cards

Lender..................................Balance........................Monthly Payment

Student Loans

Lender..................................Balance........................Monthly Payment

Other Loans

Lender..................................Balance........................Monthly Payment

Additional information that may assist us in determining your particular loan needs ....