MORTGAGE LOAN APPLICATION

Borrower Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Date of Birth

YYYY

SSN

Co-borrower Name (if desired)

First Name

Last Name

Co-borrower Email

Co-borrower Phone

(###)

###

####

Co-borrower Date of Birth

YYYY

Co-borrower SSN

Approximate appraised value or purchase price of your home

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Years at current address

Previous address (if less than two years)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Ages of dependents (enter 0 if none)

Years in school (high school counts for 12)

Name of Borrower's Employer

Borrower's Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Borrower's Employer's Phone

(###)

###

####

Borrower's Employment Contact Name

First Name

Last Name

Years at Borrower's Employer

Borrower's Gross Monthly Income (before taxes)

Name of Co-Borrower's Employer

Co-Borrower's Employer's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Co-Borrower's Employer's Phone

(###)

###

####

Co-Borrower's Employment Contact Name

First Name

Last Name

Co-Borrower's Gross Monthly Income (before taxes)

Years at Co-Borrower's Employer

Bank Name for Checking/Savings

Approximate Balance for Checking/Savings

Approximate Balance for ALL retirement accounts

Please list any MAJOR credit issues, like bankruptcies, foreclosures, tax liens, child support, etc. If none, please enter "none".