| Borrower's First Name: |
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| Borrower's Last Name: |
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Co-Borrower's First Name |
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Co-Borrower's Last Name |
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| Address 1: |
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| Address 2:
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| City: |
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| State/Province: |
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| Zip Code: |
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| Email Address:
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| Verify Email: |
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| Home Phone: |
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| Business Phone:
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| Best time to reach you::
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| At work or home?:
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| Current mortgage holder:
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| Current Interest rate:
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| Interest rate type:
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| Current monthly mortgage payment:
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| Taxes per year:
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Insurance per year:
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Are taxes and insurance
included in the payment?:
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Yes
No
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| Original length of mortgage term:
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| Years remaining:
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| Current loan balance:
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| House Type:
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| Year home was built:
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| Approximate home value:
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| Number of bedrooms:
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| Number of Bathrooms:
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| Central air:
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Yes
No
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| Basement:
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Yes
No
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| Pool:
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Yes
No
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| Garage:
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| List major home improvements made:
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| Borrower's Employer:
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| How many years:
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| Job Title:
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| Employers Address:
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| Employer's Phone:
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| Employer's Fax:
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| Wages:
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| Frequency of wages:
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| Co-Borrower's Employer:
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| How many years:
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| Job Title:
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| Employer's Address:
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| Employer's Phone:
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| Employer's Fax:
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| Co-borrower's Wages:
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| Frequency of wages:
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| Have you ever filed bankruptcy:
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| If yes, year of discharge:
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| Do you have any assets:
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401K
Stocks
Bonds
Checking
Savings
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| Any late payments on bills:
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| Interested in Debt Consolidation:
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Yes
No
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| How much:
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| Would you like cash out:
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Yes
No
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| How much:
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| Rate your credit:
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Excellent
Good
Fair
Poor
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| Are you currently in credit counseling:
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Yes
No
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| Do we have permission to pull your credit:
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Yes
No
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| Borrower's Birthdate:
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| Borrower's Social Security No.:
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| Co-borrower's Birthdate:
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| Co-borrower's Social Security No.:
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| How long have you owned your home:
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| How long do you plan to live there:
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| What are your goals:
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| Any specific needs or preferences:
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| Comments:
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