Client Information

Please fill out the following form as accurately as you can

Client Information
How Were You Referred to This Site?

1003 Borrower Information
First Name:		SSN/Tax Id:
Middle Initial:		Home Phone:
Last Name:		Yrs. Employed in Current Position:
Suffix:		Age:
Self-Employed:		Work Phone:

1003 Co-Borrower
First Name:		SSN/Tax Id:
Middle Initial:		Home Phone:
Last Name:		Yrs. Employed in Current Position:
Suffix:		Age:
Self-Employed:		Work Phone:

Additional Borrower Information		Additional Co-Borrower Information
Have You Had an Ownership interest in a property in the last 3 years?
Type of Property Owned:
Title Held:
Do You Intend to Occupy the Property as Your Primary Residence:
Present Address:
City:
State:
Zipcode:
Years at Present Address:
Previous Address Street If Less Than 2 Years at Current Address:
Previous Address City:
Previous Address State:
Previous Address Zip:

Income/Asset/Liabilities	Borrower	Co-Borrower
Salary and Self Employment Income (Monthly):	$
All Other Income (Monthly):	$
Vested Interest In Retirement Fund:	$
Liquid Assets:	$
Gift Assets:	$
Proceeds From Sale of Real Estate:	$
Total Non Housing Payments (Credit Card, Installment Loans):	$
Total Current Housing Expense (Mortgage Payment/Rent):	$
Total Outstanding Debt (Credit Card, Installment Loans (Gross Amt.)	$
If Refinance What is Payoff on Current Residence?	$

Property Information
Street Address:		Sales Price:
City:		Estimated Value (Refi Only):
State:		Will this property be owner occupied?
Zip Code		The following information only apply to new Condo or PUD Projects:
Number of Units:		No. units in Project:
Year Built (optional):		Is PUD or Condo project 50% Sold?
Year Acquired:		e-mail address:

The information in this application is true and may be relied on in evaluating this loan request. You are authorized to check my credit and employment plus answer any questions regarding my credit experience with you. I understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on loan applications made to federally insured financial institutions

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