"Five Minute Application"

Contact Information:
How did you hear about us?
I want to:
Purchase Price:
Loan Amount:
Borrower Married Unmarried
First Name:
Last Name:
SSN:
Date of Birth:
Home Phone:
Cell Phone:
Email Address:
Co-Borrower Married Unmarried
First Name:
Last Name:
SSN:
Date of Birth:
Home Phone:
Cell Phone:
Email Address:
Present Address:
Own / Rent:
Street Address:
City:
Years at this address:
State:
Zip Code:
Subject Property:
Type of Property:
Street Address:
City:
Occupancy:
State:
Zip Code:
Monthly Housing Expense & Liabilities:
  Monthly Payments
Mortgage / Rent:
2nd Mortgage:
Property Taxes & Insurance:
Monthly Debt (Credit Cards, Auto Loans, Student Loans, etc)
Total:
Gross Monthly Income:
Borrower
Base:
Bonus:
Commission:
Overtime:
Other:
Total:
Co-Borrower
Base:
Bonus:
Commission:
Overtime:
Other:
Total:
Employment Information:
Borrower
Self Employed?
Name and Address of Employer:
Employer Name:
Job Title:
Street Address:
City:
State:
Zip Code:
Years on this Job:
Years in this industry:
Co-Borrower
Self Employed?
Name and Address of Employer:
Employer Name:
Job Title:
Street Address:
City:
State:
Zip Code:
Years on this Job:
Years in this Industry:
Previous Employer (If Employed In Current Position for Less Than Two Years):
Borrower
Self Employed?
Name and Address of Employer:
Name:
Job Title:
Street Address:
City:
State:
Zip Code:
Years on this Job:
Years in this Industry:
Co-Borrower
Self Employed?
Name and Address of Employer:
Name:
Job Title:
Street Address:
City:
State:
Zip Code:
Years on this Job:
Years in this Industry:
Assets - Checking, Savings, Gift:
Checking Accounts:
Savings Accounts:
Stocks & Bonds:
CD's & Money Markets:
Retirement Funds - 401(k), IRA, etc...
Gift Funds from a Relative:
Total Liquid Assets:
Declarations:
  Borrower Co-Borrower
Have you been declared bankrupt in the last 7 years? Yes No Yes No
Have you had a property foreclosed upon in the last 7 years? Yes No Yes No
Do you intend to occupy the property as your primary residence? Yes No Yes No
Are you presently delinquent or in default on any federal debt? Yes No Yes No
Have you owned any Real Estate in the last 3 years? Yes No Yes No
Are you a U.S. citizen? Yes No Yes No
Are you a permanent resident alien? Yes No Yes No

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