First Time Homebuyer(s)? YesNo

Applicant Name (s)

Purpose of Application PurchaseRefinanceRenewalHome Equity LOCPurchase + Improvements

Phone

Email

Requested Mortgage Amount

How Would You Rate Your Credit Score ExcellentGoodMediocreWeak

Do You OwnRentBoth (Rent & Own)

If you RENT, How much do you pay per month?

If you OWN: What is the assessed value of your house?

If you OWN: What is your approximate mortgage balance?

If you OWN: How much are your property taxes this year?

Do you own multiple properties YesNo

Income p/yr:(If 2 applicants format as $40,000 + $30,000)

Income Type Self-EmployedSalary EmployeeHourly EmployeeCombination

Total $$ amount available for Downpayment and Closing Costs (Include Gifts)

Liabilities: Total $$ amount of all debts, excluding your first mortgage, but including Credit Cards, Vehicle Loans etc.