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Borrower Name
First:*
MI:
Last:*
Borrower Phone
Home:*
Work:
Cell:
E-mail:*
Borrower Current Address
Street:*
City:*
State:*
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Zip:*
Do you rent or own?
How many years?
Monthly Payment:
SSN#:
Date of Birth:
Borrower Employment
Company Name:
Title/Position:
Company Address:
Company Phone:
Monthly Amount:
Years with Company:
Years in Industry:
Borrower Other Income
Source:
Amount per month:
Borrower Bank Accounts
(Current Balances)
Bank Name:
Checking:
Savings:
Other:
Type of Transaction:
Purchase
Refinance (Rate & Term)
Refinance (Cash Out/Debt Consolidation)
Construction to Perm
Other
Estimated Closing Date:
If purchase: Has contract been accepted?
Yes
No
Occupancy:
Primary
Secondary (Vacation)
Investment
Subject Property Address
Street:
Sales Price:
City:
Down Payment:
State:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Loan Amount:
Zip:
Desired Term/Product:
30 yr fixed
15 yr fixed
5 yr ARM
3 yr ARM
Other
Property Value:
Additional Accounts
(Total balance of all accounts)
Retirement Accounts:
Stock Accounts:
Other Accounts:
Current Real Estate Agent
First Name:
Last Name:
Company Name:
Phone Number:
Loan Officer:
N/A
Charlie Branham
Tim Buice
Laura Hill
Greg McCoy
Tanya Gann
Josh Collins
Bob McGregor
Glen Osborne
Brian Foxworth
Eugenia Bambas
Lori LeBoeuf
Ned Claasen
Dan Hane
Eric Feuerstein
Mike Tatum
Jan Lahan
Jennifer Grigg
Amber Davis
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Co-Borrower Name
First:
MI:
Last:
Co-Borrower Phone
Home:
Work:
Cell:
E-mail:
Co-Borrower Current Address
Street:
City:
State:
Zip:
Do you rent or own?
How many years?
Monthly Payment:
SSN#:
Date of Birth:
Co-Borrower Employment
Company Name:
Title/Position:
Company Address:
Company Phone:
Monthly Amount:
Years with Company:
Years in Industry:
Co-Borrower Other Income
Source:
Amount per month:
Co-Borrower Bank Accounts
(Current Balances)
Bank Name:
Checking:
Savings:
Other:
