"*" indicates required fields Step 1 of 7 14% Please fill out your information in this form completely. Name* First Name Last Name Phone*Please provide a phone number as we will need to call to clarify objectives.Email* Reason for Loan* Please fill out your information in this form completely. Address Address Line 1 City State / Province / Region ZIP / Postal Code How Long Have You Lived in this Home?1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years13 Years14 Years15 Years16 Years17 Years18 Years19 Years20 Years21 Years22 Years23 Years24 Years25 Years26 Years27 Years28 Years29 Years30 Years30+ Years Please fill out your information in this form completely. Why Do You Want This Loan?* Purchase Refinance Purchase Price* Down Payment Amount* Type of Property*Primary ResidenceSecond / Vacation HomeInvestment PropertyDesired Term*30 Year10 Year15 Year20 YearDesired Loan Type*Fixed RateAdjustable RateProperty Value* Type of Property*Primary ResidenceSecond / Vacation HomeInvestment PropertyCurrent Interest Rate* Current Loan Type*Fixed RateAdjustable RateSecondary Interest Rate Secondary Loan TypeFixed RateAdjustable Rate Please fill out your information in this form completely. Employer Name Job Title Date Started MM slash DD slash YYYY Please fill out your information in this form completely. Monthly Gross Income Please fill out your information in this form completely. Name of Institution Account TypeCheckingSavingsRetirementOtherBalanceName of Institution #2 Account Type #2CheckingSavingsRetirementOtherBalance #2Name of Institution #3 Account Type #3CheckingSavingsRetirementOtherBalance #3Name of Institution #4 Account Type #4CheckingSavingsRetirementOtherBalance #4Describe any other assets to be considered Please fill out your information in this form completely. Social Security Number Date of Birth MM slash DD slash YYYY Is There a Co-Borrower?* Yes No Co-Borrower Name* First Last Co-Borrower Email* Co-Borrower Phone*Co-Borrower Employer Co-Borrower Employee Title Co-Borrower Date Employment Started MM slash DD slash YYYY Co-Borrower Monthly IncomeCo-Borrower Social Security Number Co-Borrower Birthdate MM slash DD slash YYYY Does the Co-Borrower Have Different Assets Than the Primary Borrower?* Yes No Name of Institution (for Co-Borrower) Account Balance (for Co-Borrower)Name of Institution #2 (for Co-Borrower) Account Balance #2 (for Co-Borrower)Name of Institution #3 (for Co-Borrower) Account Balance #3 (for Co-Borrower)Describe Any Other Assets to be Considered as a Co-BorrowerDoes The Co-Borrower Live at the Same Address?* Yes No Co-Borrower Address Street Address City State / Province / Region ZIP / Postal Code I give permission to pull my credit* Yes No
