Loan Specifics

1. If you currently have a house under contract, please provide the address, city, and zip code:

2. What type of loan are you seeking?
 Purchase Refinance

3. Are you currently working with a Realtor or agent? If so, please provide their name and number.
Realtor Name:
Realtor Phone:

4. Will this property be Owner Occupied or an Investment
 Owner Occupied Investment Property

5. What kind of loan product(s) are you seeking? (Check all that apply)
 Conventional Loan FHA VA Jumbo 203K Construction Perm Don't know

6. How much do you have set aside to use as a down payment?
Amount $

7. Do you need Down Payment Help?
 Yes No Not Sure

Personal Information

1. Full Legal Name:

2. Current Address, City, State, Zip Code:

3. Current Home Phone:

4. Alternate Phone:

5. Previous Address, City, State, Zip: (if not at your current address for at least two years):

6. Married Status:
 Married Separated Single

7. Do you currently own or rent?
 Own Rent

Employment Information

1. Current Employer:

2. Employer Address:

3. Title/Position:

4. Gross income (please indicate if amount is per year/month/week/hourly):

5. Hours worked per week:

6. Previous Employer (if not at current job at least two years):

7. Previous Employer Address:

8. Previous Title/Position:

Spouse's Personal Information (if Married)

1. Spouse's Full Legal Name:

2. Spouse's Current Address, City, State, Zip Code:

3. Spouse's Current Home Phone:

4. Spouse's Alternate Phone:

5. Spouse's Previous Address, City, State, Zip: (if not at your current address for at least two years):

Spouse's Employment Information (If Applicable)

1. Spouse's Current Employer:

2. Spouse's Employer Address:

3. Spouse's Title/Position:

4. Spouse's Gross income (please indicate if amount is per year/month/week/hourly):

5. Spouse's Hours worked per week:

6. Spouse's Previous Employer (if not at current job at least two years):

7. Spouse's Previous Employer Address:

8. Spouse's Previous Title/Position:

Banking Information

1. With whom do you bank? (list all names of banking institutions, separated by commas):

2. Your normal monthly checking account balance:
Amount $

3. Your total balance in Savings Account(s):
Amount $

4. Total additional savings held in money market accounts, 401k, 403b, retirement accounts (if any):
Amount $

5. Current Total Investment Portfolio (stocks, bonds, mutual funds, other):
Amount $

6. Name of Brokerage (if applicable):

Credit Information

1. In general, how is your credit right now?

2. Have either you or your spouse had a bankruptcy within the last seven years?
 Yes No

Contact Information

1. What time is best to call and gather additional confidential information needed in order to complete the application process?

2. What is the best phone number to reach you for this purpose?

3. What is the best email address to reach you?