Borrower Information
Borrower Name:
Social Security#:
Date of Birth: (mm/dd/yy)
Street Address:
City:
State:
Zip:
How long have you been at the above address?
Do you own or rent this property?
If less than 2 years at above address, please input your previous address and how long you live there:
Home Phone Number:
Work Phone Number:
Race/National Origin :
If other, please specify:
E-mail Address:
Marital Status:
Years of School:
Co-Borrower Information
Co-Borrower Name:
Social Security#:
Date of Birth: (mm/dd/yy)
Street Address:
City:
State:
Zip:
How long have you been at the above address?
Do you own or rent this property?
If less than 2 years at above address, please input your previous address and how long you live there:
Home Phone Number:
Work Phone Number:
Race/National Origin :
If other, please specify:
E-mail Address:
Marital Status:
Years of School:
Borrower Employment Information
Company Name:
Company Address:
Job Title:
Dates of Employment:(mm/dd/yy)
to present
Annual Salary:

If less than 2 yrs in current position, please list the following info from your previous employer:
Company Name:
Title:
Dates of Employment:(mm/dd/yy) to
Income:
$
Type of business:
Address of previous company:
Co-Borrower Employment Information
Company Name:
Company Address:
Job Title:
Dates of Employment:(mm/dd/yy)
to present
Annual Salary:

If less than 2 yrs in current position, please list the following info from your previous employer:
Company Name:
Title:
Dates of Employment:(mm/dd/yy) to
Income:
$
Type of business:
Address of previous company:
Monthly Income and Combined Housing Expense Information

Gross Monthly Income
Borrower
Co-
Borrower
Total
Combined
Monthly
Housing
Expense
Present
Base Employment Income*
$ $ $
Rent
$
Overtime
$ $ $
1st Mort. (P & l)
$
Bonuses
$ $ $
Other Financing
$
Commissions
$ $ $
Hazard Insurance
$
Dividends/Interest
$ $ $
Real Estate Taxes
$
Net Rental Income
$ $ $
Mortgage Insurance
$
Other
$ $ $
Other
$
TOTAL
$ $ $
TOTAL
$

*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income Notice: Alimony, Child Support, or separate maintenance income need to be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C
Monthly Amount
Assets and Liabilities
This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If spouse completed the Co-Borrower section, this Statement and supporting schedules must be completed about that spouse also.

Assets
Cash or Market Value
List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Name and address of Bank, S&L, or Credit Union:
Acct no. $
Stocks & Bonds (Company name/number & Description)

Life Insurance net cash value
Face amount: $
$
Subtotal Liquid Assets $
Real Estate owned (enter market value from schedule of real estate owned) $
Vested interest in retirement fund $
Net worth of business(es) owned (attach financial statement) $
Automotive owned (make and year)

$
Other Assets (itemized)

$
Total Assets a. $


Schedule of Real Estate Owned
Property Address
Type
Present
Market
Value
Amount of Mortgage & Liens
Gross
Rental
Income
Mortgage
Payments
Insurance,
Maintenance,
Taxes & Misc.
Net Rental Income
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
$ $ $ $ $ $
VII. DECLARTIONS
Borrower Co-Borrower
a. Are there any outstanding judgments against you? YN YN
b. Have you been declared bankrupt within the past 7 years? YN YN
c. Have you had properly foreclosed upon or given title or deed in lieu thereof in the last 7 years? YN YN
d. Are you a party to a lawsuit? YN YN
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? YN YN
f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage financial obligation, bond, or loan, guaranteed? YN YN
g. Are you obligated to pay alimony, child support, or separate maintenance? YN YN
h. Is any part of the down payment borrowed? YN YN
i. Are you a co-maker or endorser on a note? YN YN
j. Are you a US citizen? YN YN
k. Are you a permanent resident alien? YN YN
l. Do you intend to occupy the property as your primary residence? YN YN
m. Have you had ownership interest in a property in the last three years? YN YN
(1) What type of property did you own - principle residence (PR), second home (SH), or investment property (IP)?
(2) How did you hold the title to the home - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?



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