To apply for a mortgage, please answer the questions below.

Borrower's Information Co-Borrower's Information
First Name First Name
Last Name Last Name
Social Security Number Social Security Number
Home Phone Home Phone
Date Of Birth Date Of Birth
Marital Status Marital Status
Email Address Email Address
Present Address Present Address
Current Residence Current Residence
For How Many Years? For How Many Years?
Occupation Occupation
Two Year Employment History Two Year Employment History
Business Phone Business Phone
Gross Monthly Income Gross Monthly Income
Monthly Rent/Mortgage Payment Monthly Rent/Mortgage Payment
Insurance Agent's Name & Phone Insurance Agent's Name & Phone

Property Information and Purpose of Loan

What is the Loan Purpose?
What is the Property Type?
How Long Do You Plan to Own?
What Type of Loan Do You Want?

Assets

Average Monthly Checking Account Balance
Average Monthly Savings Account Balance
Market Value of Retirement Account
Life Insurance Net Cash Value
Company Names and Market Values of Held Stocks / Bonds
List All Real Estate Owned Properties
(include market value, liens, mortgage payments, insurance, and taxes for each property)

Declarations

Has Borrower/Co-Borrower Declared Bankruptcy or Foreclosure Within Last 7 Years?
Are There Any Outstanding Judgements Against Either of You?

Additional Comments