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Borrower Co-borrower
(If different)
Full Name:
Address:
City, State, Zip
Home Phone:
Length at current residence:
Previous address if less than 2 years
City, State, Zip
Work Phone:
Best time to contact:
E-mail:
Social Security #:
Employers:
Employer(s) Address
Employer(s) City
Employer(s) State
Employer(s) Zip
Employers' Phone Number:
Are you self employed ? Yes No Yes No
Length of Employment:
Current Job Title:
Gross Monthly Income:
Date of Birth:
My credit history is: excellent
good, but some lates
some credit problems
major credit problems
don't know
excellent
good, but some lates
some credit problems
major credit problems
don't know



Bank Information

Bank 1

Name of Bank:
Average Balance:
Account Number:
Type of Account

Bank 2

Name of Bank:
Average Balance:
Account Number:
Type of Account

Bank 3

Name of Bank:
Average Balance:
Account Number:
Type of Account



Loan Request

Amount Requested:
Type of loan:



Property Information

*This information needs to be filled out for the property that is collateral for the loan

Street Address:
City, State, Zip Code:
Estimated Present Value:
Year Purchased:
Original Price:
Type of Property: Primary Second/Vacation Investment
Purchase Amount:



Loan Information

Mortgage Balances
Amount:
Held by:
Payment:
First:
Second:
Other:



Creditors

Name Amount Owed Monthly Payment
Will be paid off?
$ $ Yes No
$ $ Yes No
$ $ Yes No
$ $ Yes No

Other monthly debts and information - please describe




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