Loan Application Form

Borrower Name

Co-Borrower Name

Phone Number

Co-Borrower Phone Number

Email Address

Co-Borrower Email Address

Current Residence

How Long at the Residence?

We need to: We need to: Refinance Purchase Second Mortgage for Consolidation

Own or Rent? Own or Rent? Rent Own

Self Employed or Wage Earner? Self Employed or Wage Earner? Self Employeed Wage Earner

Employer

How many years?

Gross Income

Co-Borrower's Employer

How many years?

Co-Borrower's Gross Income

Other Income Amount?

Approximate Balance In Checking Account This Week?

Approximate Balance In Savings?

Other Accounts?

Estimated Credit Score