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Borrower		Co-Borrower (if applicable)
Full Name:		Full Name:
Address:		Address:

City:		City:
State:		State:
Zip:		Zip:
Email:		Email:
Home Phone:	()-	Home Phone:	()-
Work Phone:	()-	Work Phone:	()-
Best Time to Call:	am pm	Best Time to Call:	am pm
Time Zone:		Time Zone:
How would you rate your credit?		How would you rate your credit?
Social Security Number:		Social Security Number:
Property Information
Property Address:

City:
State:
Zip:
Property Type:		Occupancy Type:
If other please specify:		If other please specify:
Purchase Price:		Estimate of Value:
Details of Loan Request, Monthly Income and other Expenses
Loan Amount:
Purpose of Loan:
If other please specify:
When is the loan needed?
Gross monthly income:
*Monthly housing expense:		*Include Mortgage or Rent, Insurance, Association Fees, . . .
**Other monthly expenses:		**Include Credit Card payments, Auto, other Real Estate loans, other Non-housing obligations.
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