Mortgage Application

Purpose of Loan:	*
Property Type:	*
Property Use:	*
Property Value:	$ *purchase, aim high/refinance, aim low

Full Name:	*	Social Security #:	- - *
Home Phone:	- - *	E-Mail Address:	*
Work Phone:	- -	Marital Status:	*
Cell Phone:	- -	Schooling:	*
Date Of Birth:	* * *	U.S. Citizen:	Yes No Please Select
Dependants:	Yes No

How Many:
Ages:	(Format: 2, 7, 13)

Address *
Current Residence:	*	How long at this property?	*
* * *

Yearly Taxes:	Yearly Insurance:
$	$
Date Purchased:	* * Original Cost:
*	$ A value is required.
Do You...	Yes No
Have a Home Equity Line or 2nd Mortgage?:	Select One
Own any other properties?:	Select One
Plan to make any changes to the Title?:	Select One
Escrow Preferences:	*

	Yes No Not Sure
*	*
Will gift funds be used?:	Select One

Is purchase contingent on sale of current residence?:	Select One
Could there be Septic/Title 5 Issue on current residence?:	Select One
Do you own any other Real Estate?:	Select One

Employer's Name:		Title/Position:
*		*
Address: *	Just Base Salary: $ *
* * *
Time:
At job yrs In field yrs
If self employed, how long?:		Bonus/Commision Income:
*yrs		Yes No Select One

Will there be a Co-Borrower?	Yes No Select One

Will his/her income be used to qualify?		Yes No *
Full Name:	*	Social Security #:	-- *
Date of Birth:	* * *	Marital Status:	*
U.S. Citizen:	Yes No *	Schooling:	*
Dependants:	Yes No

How Many:	*
Ages:	(Format: 2, 7, 13) *

Address: *		Just Base Salary: $ *
Employer's Name:	*	Title/Position:	*
* * *
Time: At job * yrs In field * yrs
If self employed, how long?: *
Bonus/Commision Income: Yes No Select One

Questions/Comments/Concerns:

* - denotes a required field