2)  Please tell us about yourself and your co-borrower, if applicable

	Your Information		Co-Borrower Information
First name
Middle initial
Last name
Approximate FICA Score
Age
Marital status	choose one married unmarried separated divorced		choose one married unmarried separated divorced
Present street address
Present city
Present state
Present zip code
Do you own or rent?	own  rent		own  rent
How many years have you lived at this address?
If less than 1 year, then fill in your prior address below
Prior street address
Prior city
Prior state
Prior zip code
Home Phone Number
Alternate Contact Number
Best Time to Contact You	choose any morning at home morning at alternate afternoon at home afternoon at alternate evening at home evening at alternate
Email address
3)  Please give us some information on your employment, and that of your co-borrower, if applicable
	Your information		Co-borrower information
Employment Status	choose one paid hourly salaried commissioned self employed own >24% of the firm not employed retired contract employee		choose one paid hourly salaried commissioned self employed own >24% of the firm not employed retired contract employee
Name of Company
Address
City/State/Zip
Work Phone Number
Job Title
Type of Business
Years in This Line of Work
Years on This Job
If Less Than 24 months, then:
Prior Employer
Dates of Prior Employment
4)  Please tell us about your income, and that of your co-borrower, if applicable		Note: In the spaces below, please indicate your gross income (before taxes and other deductions).  Use monthly figures.
	Your information		Co-borrower information
Self employed income
Base employment income
Commissions and/or bonus
Overtime income
Other income
5)  What are your current housing expenses?	Note: If you and your co-borrower are married, leave the co-borrower column blank unless you have separate living expenses.  Please use monthly figures only (example: annual property taxes / 12).
	Your information		Co-borrower's information
Rent
Mortgage payment (1st)
Other mortgage payment (2nd)
Hazard insurance
Real estate taxes
Mortgage insurance
Homeowner Assoc. Dues
6)  Please tell us about your assets	Note:  If you and your co-borrower are married, you may combine your assets.  For funds in an financial institution, please use the ending balance from your most recent statement.
	Your information		Co-borrower's information
Checking/Saving Accounts
Stocks and Bonds
Value of real estate owned
Other
7)  What are your monthly obligations?	Note:  If you and your co-borrower are married, you may combine your monthly debts into one figure.  Use minimum monthly payments.
	Your information		Co-borrower's information
Total payments on long term debt including installment and revolving debt, leases, support, mortgages (exclude any debts that will be paid off with this transaction)
Finally, Please tell us about your credit	Choose one Excellent Good Fair Poor I don't know		Choose one Excellent Good Fair Poor Don't know

8)  In the box below, please give us any additional information you think would be helpful to understand your situation and objectives.

Thank you for taking the time to fill out this form.  Now click on the submit button below and we will begin work on it right away.  You will receive an email response from us within 24 hours of submission, except on weekends.   We will contact you to ask any outstanding questions, and review with you the documentation that you will need to send to support your application. 

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