Borrower's First Name: |
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Borrower's Last Name: |
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Co-Borrower's First Name
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Co-Borrower's Last Name
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Address 1: |
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Address 2: |
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City: |
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State/Province: |
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Zip Code: |
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Email Address: |
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Verify Email: |
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Home Phone: |
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Business Phone: |
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Best time to reach you:: |
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At work or home?: |
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Current mortgage holder: |
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Current Interest rate: |
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Interest rate type: |
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Current monthly mortgage payment: |
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Taxes per year: |
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Insurance per year:
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Are taxes and insurance
included in the payment?:
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Yes
No
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Original length of mortgage term: |
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Years remaining: |
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Current loan balance: |
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House Type: |
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Year home was built: |
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Approximate home value: |
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Number of bedrooms: |
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Number of Bathrooms: |
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Central air: |
Yes
No
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Basement: |
Yes
No
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Pool: |
Yes
No
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Garage: |
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List major home improvements made: |
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Borrower's Employer: |
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How many years: |
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Job Title: |
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Employers Address: |
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Employer's Phone: |
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Employer's Fax: |
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Wages: |
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Frequency of wages: |
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Co-Borrower's Employer: |
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How many years: |
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Job Title: |
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Employer's Address: |
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Employer's Phone: |
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Employer's Fax: |
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Co-borrower's Wages: |
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Frequency of wages: |
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Have you ever filed bankruptcy: |
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If yes, year of discharge: |
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Do you have any assets: |
401K
Stocks
Bonds
Checking
Savings
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Any late payments on bills: |
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Interested in Debt Consolidation: |
Yes
No
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How much: |
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Would you like cash out: |
Yes
No
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How much: |
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Rate your credit: |
Excellent
Good
Fair
Poor
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Are you currently in credit counseling: |
Yes
No
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Do we have permission to pull your credit: |
Yes
No
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Borrower's Birthdate: |
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Borrower's Social Security No.: |
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Co-borrower's Birthdate: |
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Co-borrower's Social Security No.: |
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How long have you owned your home: |
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How long do you plan to live there: |
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What are your goals: |
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Any specific needs or preferences: |
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Comments: |
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