Name         Marital Status Choose One Single Married Divorced                       

Social Security                      Address              

City/State/Zip        Date of Birth                         

Email Address        Do you own or rent Choose One Own Rent             

How Long                             Rent/Mortgage Payment              

Home Phone                  Work Phone     

Employer Name        Yearly Income     

Length of Employment                Self Employed Choose One Yes No

Other Income (Alimony, Child Support, Social Security, etc)

Is there a Co-Borrower Choose One Yes No

Name of Co-Borrower

Co-Borrower Social Security

Co-Borrower Yearly Income

2. Credit

Please rate your credit Choose One Very Good Good Fair Bumpy Poor Very Poor

Very good: No mortgage lates in the last two years; perhaps an isolated 30 day late on either consumer or revolving debt.
Good: Not more than 1 mortgage late in the last 24 months; 1 or 2 thirty-day lates on revolving and/or installment.
Fair: Up to two 30-day mortgage lates in the last 24 months; three or four 30-day lates on revolving and or installment.
Bumpy: Four 30 day lates on mortgage or three 30's and one 60 day late; multiple 30 day lates and isolated 60 to 90 day lates on revolving and installment.
Poor: Multiple 30's on mortgage or two 60's and a 90 all within the last 24 months; 30's, 60's, and 90's, with isolated 120's on revolving and/or installment. Over all poor credit.
Very poor: Many lates of all kinds, NOD's or currently in foreclosure, recent Bankruptcy, multiple judgments and liens, etc.

Have you ever had a bankruptcy Choose One Never had a bankruptcy Bankruptcy discharged over 4yrs ago Bankruptcy discharged over 2yrs ago Bankruptcy discharged over 1yr ago Bankruptcy discharged less than 1yr ago Currently in bankruptcy

3. Loan Preferences

What is the purpose of your loan Choose One Purchase a new home, already located Purchase a new home, not yet found Refinance Home Equity Loan Home Improvement Loan Debt Consolidation Loan Second Mortgage

Select your preferred mortgage product Choose One Fixed Rate Adjustable Rate Balloon  

What is the approximate loan amount you wish to borrow

What is the purchase price of home or approximate value for a refinance

4. Comments

Any additional information you want us to consider or need to explain goes here.

How did you hear about us

Best time to reach you

I authorize credit and employment history to be verified Choose One Yes No

**You are not obligated to accept this loan even if your application is approved.