Current Date:
Loan Purpose:	Purchase Refinance Equity Line
Purchase Price or Present Value:
Current loan Balance (if applicable):
Current Interest Rate:
Current Loan Type:	Fixed Rate Variable
Loan Amount Requested:
Loan Type Requested:	Conventional VA FHA Sub-Prime
Amortization Type:	30 Year 15 Year 40 Year
Lien Priority:	First Mortgage Second Mortgage
Loan program Requested:	Fixed Rate Variable Rate Three Year Fixed Five Year Fixed Uncertain
Property Address:
City:
State:
Zip:
County:
Balloon:	None Yes
Units:	Single Family Duplex Tri-Plex Four-Plex
Year Built:
Building:	Existing New Construction
Cash Out:	Yes No
Occupancy:	Owner Occupied Rental
2nd Included (Refinance only):	Yes No
Borrower First Name:
Borrower Last Name:
Borrower Address:
Borrower City:
Borrower State:
Borrower Zip Code:
Borrower Self Employed?:	Yes No
Borrower Social Security:
Borrower length at Current Address (years):
Previous Address (if less than 2 yrs at Current Address):
Previous Address (continued):
Bankruptcy:	Yes No
Foreclosure:	Yes No
Work Phone:
Home Phone:
Co-Borrower First Name:
Co-Borrower Last Name:
Co-Borrower Address:
Co-Borrower City:
Co-Borrower State:
Co-Borrower Zip Code:
Co-Borrower Self Employed?:	Yes No
Co-Borrower Social Security:
Co-Borrower length at current Address (years):
Previous Address (if less than 2 yrs at Current Address):
Previous Address (continued):
Bankruptcy:	Yes No
Foreclosure:	Yes No
Work phone:
Home Phone:
Gross Total Monthly Income:
Monthly Minimum Credit Card Payments:
Monthly Combined Auto Payments:
Monthly Combined Installment Loans:
Current Home Payment/Rent:
Down payment (purchase only):
Loan officer (if applicable):
Office location (if applicable):
Authorization To Check Credit:	Yes No
Email Address:
Please Write Any Additional Comments: