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Purpose of Loan:
Purchase   
Refinance   
Borrower
Borrower Name
Address
City
 State
 Zip Code
Phone
Employment Information - Borrower
Self-Employed
Yes    No   
Name of Employer
Position
Years Employed
Gross Monthly Salary
Co-Borrower
Co-Borrower Name
Address
City
 State
 Zip Code
Phone
Employment Information - Co-Borrower
Self-Employed
Yes    No   
Name of Employer
Position
Years Employed
Gross Monthly Salary
Approximate Value of Property?
Current Balance of First Mortgage
Monthly Payment
Current Interest Rate
Type of Loan
Fixed    Adjustable   
Escrows
Yes    No   
Current Balance of Second Mortgage
Monthly Payment
Current Interest Rate
Type of Loan
Fixed    Adjustable   
Comments/Questions

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