* Required Information  

 *Borrower First Name / Last Name

*Social Sec:

 *Co-Borrower First Name / Last Name

*Social Sec:

 *1st MTG Amount

*Lender

 *2nd MTG Amount

*Lender

 *1st Mtg

 *Type:Arm,Fixed, I/O

*Interest Rate

 *2nd Mtg

 *Type:Arm,Fixed, I/O

*Interest Rate

 Property Address

Please check all that apply.

 

 Property City, State, Zip

I live in this home

 

 

 

 

Occupants in home

 

 

 Work Phone

This is a 2nd Home

 

 Home Phone

This house is vacant

 

 Cell Phone

This is rental property

 

 Email

Monthly Rent Amount

 

 Mailing Address

Active Bankruptcy

 

 Mailing City, State, Zip

 

 

 

 

 

 

 

 

  Employment Information  

 

 

 Borrower Employer

Co-Borrower Employer

 

 Borrower Position

Co-Borrower Position

 

 Household Income

Primary Houseowner

Additional Occupants

 

 

 

        Gross                                  Net

 

        Gross                              Net

 

 Employment Income

       

 

    

 

 Disability

       

 

    

 

 Rental Income

       

 

    

 

 Unemployment

       

 

    

 

  Child Sup/ Alimony

       

 

    

 

  Other 

       

 

    

 

  Total Monthly Income

       

 

    

 

  Other Income Frequency

Weekly, Mo, Etc                

 

Weekly, Mo, Etc             

  Employment Status Fulltime, Part-Time, etc.

 

 

  DEBT      

 

Balance Due

Monthly Payment

Interest Rate

 

 Auto Loan #1

                   

 

 Auto Loan #2

                   

 

 Credit Card #1

                   

 

 Credit Card #2

                   

 Credit Card #3

                   

 

 Credit Card #4

                   

 Installment Loan

                   

 

 Mortgage Payment

                   

  2nd Mortgage Payment

                   

  Personal Loans

                   

  Unsecured Debt

                   

  Other Debts

                   

 Totals

                   

 

       

 

    

 

   

 

    

 

 Rental Income

MONTHLY HOUSEHOLD LIABILITIES AND EXPENSES

   Monthly Payment

 

 
MonthlyPayment

 

  Alimony / Child Support

                                        

Hospital

    

 

  Auto Expense, Gas, tc.

                                        

Prescriptions

    

 

  Child Care / Elder Card 

                                      

Cable

    

 

  Education

                                   

Water

    

 

  Food - Family

                                        

Electricity

    

 

  Pets

                                      

Gas

    

 

  Spending Money

                                     

Phone / Cell / Internet

    

 

  Other Expenses

                                        

Clothing

    

 

  Auto Insurance

                                        

Dry Cleaning

    

 

  Health Insurance

                                        

Monthly Parking

    

 

  Personal Life Insurance

                                      

Club or Union Dues

    

 

  Other Expenses #2

                                      

School or Work Lunches

    

 

  Other Mortgages

                                      

HOA Dues

    

 

  Totals

                                      

Totals

    

 

 

                                       

 

    

 

  Net Income

                                        

 

    

 

  Minus Expenses

                                      

 

    

 

  Surplus / Negitiv

                                      

 

    

 

  Upfront Funds Available